Heart Failure

Question 1

STICH trial. Primary hypothesis?

Answer 1

Surgical Treatment for Ischemic Heart Failure

(i) CABG with optimal medical therapy (OMT) was superior to OMT alone
(ii) CABG with surgical ventricular reconstruction (SVR) would be superior to CABG alone

Question 2

STICH trial inclusion criteria

Answer 2

Patients with ischemic cardiomyopathy with EF<35%

Question 3

STICH trial findings with the hypothesis CABG + SVR vs CABG

Answer 3

a. LV volume decreased significantly with reconstruction
b. No differences in symptomatic improvement, death, or repeat hospitalization
c. Patients with smaller ventricles (LVESVI <60 mL/m2) and better LVEF (≥ 33%) may have benefited by SVR.

Question 4

STICH trial findings with the hypothesis CABG + OMT vs OMT alone

Answer 4

After 5 years, CABG + OMT does not significantly reduce all-cause mortality. However, there is a reduction of CV-related deaths and hospitalizations.

After 10 years, there is a significant reduction in all-cause mortality with CABG.

Question 5

Indication for total artificial heart

Answer 5

Bridge to transplantation in irreversible cardiomyopathy with BiV failure.

Question 6

Heart failure definition

Answer 6

A clinical syndrome that results from a structural or functional impairment of the ventricular filling or ejection of blood. Cardinal manifestation include dyspnea, fatigue, exercise intolerance, fluid retention, pulm/splanchnic/ peripheral edema.

Question 7

HFrEF is defined as

Answer 7

clinical symptoms of HF and EF <40%, AKA systolic heart failure. In comparison to HFpEF, only patients with HFrEF that efficacious therapies have been demonstrated.