Details

Autor(en) / Beteiligte

• Cleland, John G.F.
• Calvert, Melanie
• Freemantle, Nick
• Arrow, Yvonne
• Ball, Stephen G.
• Bonser, Robert S.
• Chattopadhyay, Sudipta
• Norell, Michael S.
• Pennell, Dudley J.
• Senior, Roxy

Titel

The Heart Failure Revascularisation Trial (HEART)

Ist Teil von

• European journal of heart failure, 2011-02, Vol.13 (2), p.227-233

Ort / Verlag

England: Blackwell Publishing Ltd

Erscheinungsjahr

2011

Quelle

Wiley-Blackwell Journals

Beschreibungen/Notizen

• Aims Revascularization is frequently advocated to improve ventricular function and prognosis for patients with heart failure due to coronary artery disease, especially when there is evidence of extensive myocardial viability. Methods and results Patients with heart failure, coronary artery disease, and a left ventricular (LV) ejection fraction <35%, who had a substantial volume of viable myocardium with contractile dysfunction assessed by any standard imaging technique, were randomly assigned to a strategy of conservative management vs. angiography with the intent of percutaneous or surgical revascularization. Patients requiring revascularization for angina or too frail for surgery were excluded. Only 138 of the planned 800 patients were enrolled because of withdrawal of funding due to slow recruitment. Also, a larger trial (The Surgical Treatment for Ischemic Heart Failure Trial) addressing a similar question became available, which investigators were encouraged to join. Of 69 patients assigned to the invasive strategy, 6 refused angiography, 2 died as a result of the diagnostic procedure, 14 were considered unsuitable for revascularization, 2 refused surgery, and 45 had revascularization. After a median follow‐up of 59 (inter‐quartile range: 33–63) months, there were 51 (37%) deaths; 25 (37%) in those assigned to the conservative strategy, and 26 (38%) in those assigned to the invasive strategy, 13 (29%) of whom had been revascularized. Conclusion A conservative management strategy may not be inferior to one of coronary arteriography with the intent to revascularize in patients with heart failure, LV systolic dysfunction, and extensive myocardial viability. However, this study was underpowered and, further, larger trials are required to settle this issue. Clinical trials Registration No: ISRCTN86284615