Severity of remodeling, myocardial viability, and survival in ischemic LV dysfunction after surgical revascularization

Robert O. Bonow, Serenella Castelvecchio, Julio A. Panza, Daniel S. Berman, Eric J. Velazquez, Robert E. Michler, Lilin She, Thomas A. Holly, Patrice Desvigne-Nickens, Dragana Kosevic, Miroslaw Rajda, Lukasz Chrzanowski, Marek Deja, Kerry L. Lee, Harvey White, Jae K. Oh, Torsten Doenst, James A. Hill, Jean L. Rouleau, Lorenzo Menicanti

Research output: Contribution to journalArticlepeer-review


Objectives This study sought to test the hypothesis that end-systolic volume (ESV), as a marker of severity of left ventricular (LV) remodeling, influences the relationship between myocardial viability and survival in patients with coronary artery disease and LV systolic dysfunction. Background Retrospective studies of ischemic LV dysfunction suggest that the severity of LV remodeling determines whether myocardial viability predicts improved survival with surgical compared with medical therapy, with coronary artery bypass grafting (CABG) only benefitting patients with viable myocardium who have smaller ESV. However, this has not been tested prospectively. Methods Interactions of end-systolic volume index (ESVI), myocardial viability, and treatment with respect to survival were assessed in patients in the prospective randomized STICH (Comparison of Surgical and Medical Treatment for Congestive Heart Failure and Coronary Artery Disease) trial of CABG versus medical therapy who underwent viability assessment (n = 601; age 61 ± 9 years; ejection fraction 2 (hazard ratio [HR]: 0.85; 95% confidence interval [CI]: 0.56 to 1.29) was no different than in patients with viability and ESVI >84 ml/m2 (HR: 0.87; 95% CI: 0.57 to 1.31). Other ESVI thresholds yielded similar results, including ESVI

Original languageEnglish
Pages (from-to)1121-1129
Number of pages9
JournalJACC: Cardiovascular Imaging
Issue number10
Publication statusPublished - Oct 1 2015


  • coronary artery bypass surgery
  • coronary artery disease
  • heart failure
  • myocardial viability

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging


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