Abstract 15982: Impact of Baseline Right Ventricular Dysfunction on the Effect of Adding Ventricular Reconstruction to Surgical Revascularization in Patients with Ischemic Cardiomyopathy. Insights from STICH trial
Rationale:Right ventricular (RV) dysfunction is associated with poor exercise capacity and prognosis in patients with ischemic cardiomyopathy. Our aim was to examine the impact of associated RV dysfunction on long-term survival in patients with coronary artery disease (CAD) and left ventricular (LV) dysfunction undergoing surgical revascularization (CABG) with or without surgical ventricular reconstruction (SVR).
Methods: The STICH trial SVR hypothesis arm randomized 1,000 patients with CAD, LV ejection fraction ≤35% and anterior wall akinesis to undergo CABG alone or CABG+SVR. Of these, 866 patients had baseline 2D echocardiograms in which RV function could be assessed qualitatively and categorized as normal, mild, moderate, or severe dysfunction. Patients were followed for a median of 48 months with all-cause mortality or cardiovascular hospitalization as the primary endpoint and all-cause mortality itself as the secondary endpoint.
Results: Mild RV systolic dysfunction was found in 102 (12%)patients, and moderate or severe RV dysfunction was observed in 78 (9%) patients. The reminder 686 patients had normal RV function. Moderate to severe RV dysfunction was associated with larger LV, lower EF, more severe MR, higher filling pressure, and higher PASP (all p<0,0001, non-parametric test). Significant interaction between RV dysfunction and treatment allocation (CABG vs. CABG+SVR) was observed on both the composite primary endpoint(p=0.046) and the secondary endpoint of all-cause mortality(p=0.008). Patients with moderate or severe baseline RV dysfunction who received CABG+SVR had significantly worse outcomes compared to patients who received CABG alone on both the primary endpoint (HR=1.86;CI=1.06-3.26;p=0.028) and the secondary endpoint (HR=3.37;CI=1.36-8.37; p=0.005).In contrast, the treatment effect of CABG+SVR vs. CABG was not significantly different between patients with normal RV function and those with mild RV dysfunction.
Conclusion: In patients with ischemic cardiomyopathy, RV dysfunction appears to reflect LV abnormalities. When baseline RV function is moderate to severely reduced, the addition of SVR to CABG may worsen long-term survival.
- © 2012 by American Heart Association, Inc.