Choi Jin-Oh, Daly Richard C, Lin Grace, Lahr Brian D, Wiste Heather J, Beaver Thomas M, Iacovoni Attilio, Malinowski Marcin, Friedrich Ivar, Rouleau Jean L, Favaloro Roberto R, Sopko George, Lang Irene M, White Harvey D, Milano Carmelo A, Jones Robert H, Lee Kerry L, Velazquez Eric J, Oh Jae K
Echocardiography Core Laboratory, Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA; Division of Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Eur J Heart Fail. 2015 Apr;17(4):453-63. doi: 10.1002/ejhf.256. Epub 2015 Mar 16.
We sought to evaluate associations between baseline sphericity index (SI) and clinical outcome, and changes in SI after coronary artery bypass graft (CABG) surgery with or without surgical ventricular reconstruction (SVR) in ischaemic cardiomyopathy patients enrolled in the SVR study (Hypothesis 2) of the Surgical Treatment for Ischemic Heart Failure (STICH) trial.
Among 1000 patients in the STICH SVR study, we evaluated 546 patients (255 randomized to CABG alone and 291 to CABG + SVR) whose baseline SI values were available. SI was not significantly different between treatment groups at baseline. After 4 months, SI had increased in the CABG + SVR group, but was unchanged in the CABG alone group (0.69 ± 0.10 to 0.77 ± 0.12 vs. 0.67 ± 0.07 to 0.66 ± 0.09, respectively; P < 0.001). SI did not significantly change from 4 months to 2 years in either group. Although LV end-systolic volume and EF improved significantly more in the CABG + SVR group compared with CABG alone, the severity of mitral regurgitation significantly improved only in the CABG alone group, and the estimated LV filling pressure (E/A ratio) increased only in the CABG + SVR group. Higher baseline SI was associated with worse survival after surgery (hazard ratio 1.21, 95% confidence interval 1.02 - 1.43; P = 0.026). Survival was not significantly different by treatment strategy.
Although SVR was designed to improve LV geometry, SI worsened after SVR despite improved LVEF and smaller LV volume. Survival was significantly better in patients with lower SI regardless of treatment strategy.
在缺血性心力衰竭外科治疗（STICH）试验的外科心室重建（SVR）研究（假设2）中，我们试图评估缺血性心肌病患者的基线球形指数（SI）与临床结局之间的关联，以及冠状动脉旁路移植术（CABG）联合或不联合SVR术后SI的变化。
在STICH SVR研究的1000例患者中，我们评估了546例基线SI值可用的患者（255例随机分配至单纯CABG组，291例随机分配至CABG + SVR组）。治疗组间基线SI无显著差异。4个月后，CABG + SVR组的SI升高，而单纯CABG组的SI无变化（分别为0.69±0.10至0.77±0.12与0.67±0.07至0.66±0.09；P<0.001）。两组在4个月至2年期间SI均无显著变化。尽管与单纯CABG组相比，CABG + SVR组的左心室收缩末期容积和射血分数改善更为显著，但二尖瓣反流的严重程度仅在单纯CABG组显著改善，而估计的左心室充盈压（E/A比值）仅在CABG + SVR组升高。较高的基线SI与术后较差的生存率相关（风险比1.21，95%置信区间1.02 - 1.43；P = 0.026）。不同治疗策略的生存率无显著差异。
尽管SVR旨在改善左心室几何形状，但尽管左心室射血分数改善且左心室容积减小，SVR术后SI仍恶化。无论治疗策略如何，SI较低的患者生存率显著更高。
