Circulation, Vol 68, 785-795, Copyright © 1983 by American Heart Association
EL Alderman, LD Fisher, P Litwin, GC Kaiser, WO Myers, C Maynard, F Levine and M Schloss
We identified 420 medically treated and 231 surgically treated patients
(coronary graft plus myocardial surgery in 30%) who had severe left
ventricular dysfunction manifest by an ejection fraction below 0.36 and
markedly abnormal wall motion. Compared with medically treated patients,
those treated surgically had more severe angina (56.7% vs 29.0% class III
or IV; p less than .001), less heart failure as predominant symptom (11.1%
vs 18.8%; p less than .003), more severe coronary disease (66.7% vs 50.2%
three-vessel disease; p less than .001), a greater concentration of left
main coronary artery lesions greater than 70% (12.6% vs 3.8%: p less than
.001), and a greater estimated extent of jeopardized myocardium (p less
than .001). Multivariate regression analysis of survival, which adjusts for
the above covariates, showed that surgical treatment prolonged survival (p
less than .05), although it ranked below severity of heart failure
symptoms, age, ejection fraction, and left main stenosis greater than 70%
in determining prognosis. Surgical benefit was most apparent for patients
with ejection fractions below 0.26 who had a 43% 5 year survival with
medical treatment vs 63% with surgery. Surgically treated patients
experienced substantial symptomatic benefit compared with medically treated
patients if their presenting symptoms were predominantly angina; however,
there was no relief of symptoms caused primarily by heart failure. We
conclude that patients with predominantly ischemic pain symptoms, despite
poor left ventricular function, benefit from surgery; however, operative
mortality in this high-risk subset must equal or better the 6.9% obtained
in this study.
ARTICLES
Results of coronary artery surgery in patients with poor left ventricular function (CASS)
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A. Pasquet, A. Robert, A.-M. D'Hondt, R. Dion, J. A. Melin, and J.-L. J. Vanoverschelde Prognostic Value of Myocardial Ischemia and Viability in Patients With Chronic Left Ventricular Ischemic Dysfunction Circulation, July 13, 1999; 100(2): 141 - 148. [Abstract] [Full Text] [PDF]
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R. Senior, S. Kaul, and A. Lahiri Myocardial viability on echocardiography predicts long-term survival after revascularization in patients with ischemic congestive heart failure J. Am. Coll. Cardiol., June 1, 1999; 33(7): 1848 - 1854. [Abstract] [Full Text] [PDF]
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 R. W. Morse, S. Noe, J. Caravalho Jr., A. Balingit, and A. J. Taylor Rest-Redistribution 201Tl Single-Photon Emission CT Imaging for Determination of Myocardial Viability: Relationship Among Viability, Mode of Therapy, and Long-term Prognosis Chest, June 1, 1999; 115(6): 1621 - 1626. [Abstract] [Full Text] [PDF]
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T. H. Marwick, C. Zuchowski, M. S. Lauer, M.-A. Secknus, M. J. Williams, and B. W. Lytle Functional status and quality of life in patients with heart failure undergoing coronary bypass surgery after assessment of myocardial viability J. Am. Coll. Cardiol., March 1, 1999; 33(3): 750 - 758. [Abstract] [Full Text] [PDF]
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S. C. Smart, P. N. Dionisopoulos, T. A. Knickelbine, T. Schuchard, and K. B. Sagar Dobutamine-atropine stress echocardiography for risk stratification in patients with chronic left ventricular dysfunction J. Am. Coll. Cardiol., February 1, 1999; 33(2): 512 - 521. [Abstract] [Full Text] [PDF]
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F. D. Loop Coronary artery surgery: the end of the beginning Eur. J. Cardiothorac. Surg., December 1, 1998; 14(6): 554 - 571. [Abstract] [Full Text] [PDF]
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M. F. Di Carli, J. Maddahi, S. Rokhsar, H. R. Schelbert, D. Bianco-Batlles, R. C. Brunken, and B. Fromm LONG-TERM SURVIVAL OF PATIENTS WITH CORONARY ARTERY DISEASE AND LEFT VENTRICULAR DYSFUNCTION: IMPLICATIONS FOR THE ROLE OF MYOCARDIAL VIABILITY ASSESSMENT IN MANAGEMENT DECISIONS J. Thorac. Cardiovasc. Surg., December 1, 1998; 116(6): 997 - 1004. [Abstract] [Full Text] [PDF]
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H. A. Dakik, N. S. Kleiman, J. A. Farmer, Z.-X. He, J. A. Wendt, C. M. Pratt, M. S. Verani, and J. J. Mahmarian Intensive Medical Therapy Versus Coronary Angioplasty for Suppression of Myocardial Ischemia in Survivors of Acute Myocardial Infarction : A Prospective, Randomized Pilot Study Circulation, November 10, 1998; 98(19): 2017 - 2023. [Abstract] [Full Text] [PDF]
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M. J. Budoff, D. M. Shavelle, D. H. Lamont, H. T. Kim, P. Akinwale, J. M. Kennedy, and B. H. Brundage Usefulness of electron beam computed tomography scanning for distinguishing ischemic from nonischemic cardiomyopathy J. Am. Coll. Cardiol., November 1, 1998; 32(5): 1173 - 1178. [Abstract] [Full Text] [PDF]
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G. D. Trachiotis, W. S. Weintraub, T. S. Johnston, E. L. Jones, R. A. Guyton, and J. M. Craver Coronary artery bypass grafting in patients with advanced left ventricular dysfunction Ann. Thorac. Surg., November 1, 1998; 66(5): 1632 - 1639. [Abstract] [Full Text] [PDF]
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J. Meluzin, J. Cerny, M. Frelich, F. Stetka, L. Spinarova, J. Popelova, R. Stipal, and on behalf of the Investigators of This Multicenter Prognostic value of the amount of dysfunctional but viable myocardium in revascularized patients with coronary artery disease and left ventricular dysfunction J. Am. Coll. Cardiol., October 1, 1998; 32(4): 912 - 920. [Abstract] [Full Text] [PDF]
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R. D. Anderson, E. M. Ohman, D. R. Holmes Jr., R. A. Harrington, G. W. Barsness, N. M. Wildermann, H. R. Phillips, E. J. Topol, and R. M. Califf Prognostic value of congestive heart failure history in patients undergoing percutaneous coronary interventions J. Am. Coll. Cardiol., October 1, 1998; 32(4): 936 - 941. [Abstract] [Full Text] [PDF]
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 W. T. Abraham Pharmacologic Management of Chronic Heart Failure: A Review Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 1998; 2(3): 168 - 190. [Abstract] [PDF]
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A. N. Kitsiou, G. Srinivasan, A. A. Quyyumi, R. M. Summers, S. L. Bacharach, and V. Dilsizian Stress-Induced Reversible and Mild-to-Moderate Irreversible Thallium Defects : Are They Equally Accurate for Predicting Recovery of Regional Left Ventricular Function After Revascularization? Circulation, August 11, 1998; 98(6): 501 - 508. [Abstract] [Full Text] [PDF]
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E De Vecchi, M G Pala, G Di Credico, V Agape, G Paolini, P A Bonini, A Grossi, and R Paroni Relation between left ventricular function and oxidative stress in patients undergoing bypass surgery Heart, March 1, 1998; 79(3): 242 - 247. [Abstract] [Full Text]
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A. Yamaguchi, T. Ino, H. Adachi, S. Murata, H. Kamio, M. Okada, and J.-i. Tsuboi Left Ventricular Volume Predicts Postoperative Course in Patients With Ischemic Cardiomyopathy Ann. Thorac. Surg., February 1, 1998; 65(2): 434 - 438. [Abstract] [Full Text] [PDF]
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M. Gheorghiade and R. O. Bonow Chronic Heart Failure in the United States : A Manifestation of Coronary Artery Disease Circulation, January 27, 1998; 97(3): 282 - 289. [Full Text] [PDF]
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C. M. Webb, R. Underwood, C. Anagnostopoulos, J. G. Bennett, J. Pepper, C. Lincoln, and P. Collins The effect of angiotensin converting enzyme inhibition on myocardial function and blood pressure after coronary artery bypass surgery--a randomised study Eur. J. Cardiothorac. Surg., January 1, 1998; 13(1): 42 - 48. [Abstract] [Full Text] [PDF]
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H. Hausmann, H. Topp, H. Siniawski, S. Holz, and R. Hetzer Decision-Making in End-Stage Coronary Artery Disease: Revascularization or Heart Transplantation? Ann. Thorac. Surg., November 1, 1997; 64(5): 1296 - 1301. [Abstract] [Full Text]
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T. M. Sundt III, S. F. Murphy, B. Barzilai, R. B. Schuessler, E. N. Mendeloff, C. B. Huddleston, M. K. Pasque, and W. A. Gay Jr Previous Coronary Artery Bypass Grafting Is Not a Risk Factor for Aortic Valve Replacement Ann. Thorac. Surg., September 1, 1997; 64(3): 651 - 657. [Abstract] [Full Text]
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S. J. Shumway, E. M. Johnson, C. A. Svendsen, J. M. Kriett, and W. S. Ring Surgical Management of Ventricular Tachycardia Ann. Thorac. Surg., June 1, 1997; 63(6): 1589 - 1591. [Abstract] [Full Text]
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G. Kleikamp, H. Posival, K. Minami, A. El-Banayosy, and R. Korfer Ischemic cardiomyopathy -- revascularization vs. transplantation Eur. J. Cardiothorac. Surg., April 1, 1997; 11(suppl): S1 - S4. [Abstract] [PDF]
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R. K. M. Chan, J. Raman, K. J. Lee, A. Rosalion, R. J. Hicks, S. Pornvilawan, B. S. T. Sia, J. D. Horowitz, A. M. Tonkin, and B. F. Buxton Prediction of Outcome After Revascularization in Patients With Poor Left Ventricular Function Ann. Thorac. Surg., May 1, 1996; 61(5): 1428 - 1434. [Abstract] [Full Text]
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R. H. Jones, K. Kesler, H. R. Phillips III, D. B. Mark, P. K. Smith, C. L. Nelson, M. F. Newman, J. G. Reves, R. W. Anderson, and R. M. Califf LONG-TERM SURVIVAL BENEFITS OF CORONARY ARTERY BYPASS GRAFTING AND PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY IN PATIENTS WITH CORONARY ARTERY DISEASE J. Thorac. Cardiovasc. Surg., May 1, 1996; 111(5): 1013 - 1025. [Abstract] [Full Text]
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M. F. Di Carli, F. Asgarzadie, H. R. Schelbert, R. C. Brunken, H. Laks, M. E. Phelps, and J. Maddahi Quantitative Relation Between Myocardial Viability and Improvement in Heart Failure Symptoms After Revascularization in Patients With Ischemic Cardiomyopathy Circulation, December 15, 1995; 92(12): 3436 - 3444. [Abstract] [Full Text]
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M. R. Costanzo, S. Augustine, R. Bourge, M. Bristow, J. B. O'Connell, D. Driscoll, and E. Rose Selection and Treatment of Candidates for Heart Transplantation : A Statement for Health Professionals From the Committee on Heart Failure and Cardiac Transplantation of the Council on Clinical Cardiology, American Heart Association Circulation, December 15, 1995; 92(12): 3593 - 3612. [Abstract] [Full Text]
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J.-L. J. Vanoverschelde, B. L. Gerber, A.-M. D'Hondt, M. De Kock, R. Dion, W. Wijns, and J. A. Melin Preoperative Selection of Patients With Severely Impaired Left Ventricular Function for Coronary Revascularization : Role of Low-Dose Dobutamine Echocardiography and Exercise-Redistribution-Reinjection Thallium SPECT Circulation, November 1, 1995; 92(9): 37 - 44. [Abstract] [Full Text]
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L. L. Mickleborough, H. Maruyama, Y. Takagi, S. Mohamed, Z. Sun, and L. Ebisuzaki Results of Revascularization in Patients With Severe Left Ventricular Dysfunction Circulation, November 1, 1995; 92(9): 73 - 79. [Abstract] [Full Text]
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S. Morita, P. Zubiate, G. L. Kay, J. M. Ruggio, G.-W. Sun, D. W. Winsor, and J. H. Kay PREDICTION OF LONG-TERM SURVIVAL BY PREOPERATIVE EXERCISE TESTING IN PATIENTS WITH DEPRESSED EJECTION FRACTION UNDERGOING MYOCARDIAL REVASCULARIZATION J. Thorac. Cardiovasc. Surg., October 1, 1995; 110(4): 944 - 951. [Abstract] [Full Text]
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Y. Moshkovitz, A. Lusky, and R. Mohr CORONARY ARTERY BYPASS WITHOUT CARDIOPULMONARY BYPASS: ANALYSIS OF SHORT-TERM AND MID-TERM OUTCOME IN 220 PATIENTS J. Thorac. Cardiovasc. Surg., October 1, 1995; 110(4): 979 - 987. [Abstract] [Full Text]
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A. Yamaguchi, T. Ino, H. Adachi, A. Mizuhara, S. Murata, and H. Kamio Left Ventricular End-Systolic Volume Index in Patients With Ischemic Cardiomyopathy Predicts Postoperative Ventricular Function Ann. Thorac. Surg., October 1, 1995; 60(4): 1059 - 1062. [Abstract] [Full Text]
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