Revascularization in heart failure and diabetes mellitus

Authors: MUDr. Marcela Tavačová
Authors‘ workplace: Národný ústav srdcových a cievnych chorôb, a. s., Bratislava
Published in: Forum Diab 2015; 4(1): 55-61
Category: Topic


Surgical revascularization should be preferred in diabetic patients with multivessel coronary artery disease. Myocardial revascularization in presence of heart failure is an acceptable treatment strategy to improve symptomatology, however right indication is crucial. Selection of patients that will benefit from revascularization is equally important as finding the patients with doubtful revascularization outcome. The aim of this article is to characterize mentioned groups of patients and to introduce current strategies of treatment, its indications, limitations and outcomes in context of evidence based medicine.

Key words:
coronary artery disease – heart failure – revascularization


1. Cleland JGF, Swedberg K, Follath F et al. The EuroHeart Failure survey programe – a survey on the quality of care among patients with heart failure in Europe. Eur Heart J 2003; 24(5): 442–463.

2. Keogh AM, Baron DW, Hickie JB. Prognostic guides in patients with idiopathic or ischemic dilated cardiomyopathy assessed for cardiac transplantation. Am J Cardiol 1990; 65(13): 903–908.

3. Rizzello V, Poldermans D, Biagini E et al. Prognosis of patients with ischaemic cardiomyopathy after coronary revascularisation: relation to viability and improvement in left ventricular ejection fraction. Heart 2009; 95(15): 1273–1277.

4. Frye RL, August P, Brooks MM, et al. A Randomized Trial of Therapies for Type 2 Diabetes and Coronary Artery Disease. N Engl J Med 2009; 360(24): 2503–2515.

5. Farkouh ME, Domanski M, Sleeper LA et al. Strategies for Multivessel Revascularization in Patients with Diabetes. N Engl J Med. 2012; 367(25):2375–2384.

6. Weintraub WS, Grau-Sepulveda MV, Weiss JM et al. Comparative Effectiveness of Revascularization Strategies. N Engl J Med 2012; 366(16): 1467–1476.

7. Yang H, Pu M, Rodriguez D et al. Ischemic and viable myocardium in patients with non-Q-wave or Q-wave myocardial infarction and left ventricular dysfunction: a clinical study using positron emission tomography, echocardiography, and electrocardiography. J Am Coll Cardiol 2004; 43(4): 592–598.

8. Camici PG. Hibernation and congestive heart failure. Heart 2004; 90(2): 141–143.

9. Greenwood JP, Maredia N, Younger JF et al. Cardiovascular magnetic resonance and single-photon emission computed tomography for diagnosis of coronary heart disease (CE-MARC): a prospective trial. Lancet 2012; 379(9814): 453–460.

10. Assomul RG, Prasad SK, Lyne J et al. Cardiovascular magnetic resonance, fibrosis, and prognosis in dilated cardiomyopathy. J Am Coll Cardiol 2006; 48(10): 1977–1985.

11. Hillenbrand HB, Kim RJ, Parker MA et al. Early assessment of myocardial salvage by contrast-enhanced magnetic resonance imaging. Circulation 2000; 102(14): 1678–1683.

12. Assomull RG, Shakespeare C, Kalra PR et al. Role of cardiovascular magnetic resonance as a gatekeeper to invasive coronary angiography in patients presenting with heart failure of unknown etiology. Circulation 2011; 124(12):1351–1360.

13. Di Carli MF, Dorbala S. Cardiac PET-CT. J Thorac Imaging 2007; 22(1): 101–106.

14. Alderman EL, Bourassa MG, Cohen LS et al. Ten-year follow-up of survival and myocardial infarction in the randomized Coronary Artery Surgery Study. Circulation 1990; 82(5): 1629–1646.

15. Kunadian V, Zaman A, Qiu W. Revascularization among patients with severe left ventricular dysfunction: a meta-analysis of observational studies. Eur J Heart Fail 2011; 13(7): 773–84.

16. Moe GW, Ezekowitz JA, O’Meara E et al. The 2013 Canadian Cardiovascular Society Heart Failure Management Guidelines Update: Focus on Rehabilitation and Exercise and Surgical Coronary Revascularization. Can J Cardiol 2014; 30(3): 249–263.

17. Tatoulis J, Buxton BF, Fuller JA. Patencies of 2127 arterial to coronary conduits over 15 years. Ann Thorac Surg 2004; 77(1): 93–101.

18. Zhao DX, Leacche M, Balaguer JM et al. Routine intraoperative completion angiography after coronary artery bypass grafting and 1-stop hybrid revascularization results from a fully integrated hybrid catheterization laboratory/operating room. J Am Coll Cardiol 2009; 53(3): 232–241.

19. Sharoni E, Song HK, Peterson RJ et al. Off pump coronary artery bypass surgery for significant left ventricular dysfunction: safety, feasibility, and trends in methodology over time – an early experience. Heart 2006; 92(4): 449–502.

20. Filsoufi F, Rahmanian PB, Gastillo JG et al. Results and predictors of early and late outcom of coronary artery bypass grafting in patients with severely depressed left ventricular function. Ann Thorac Surg 2007; 84(3): 808–816.

21. Luciani GB, Montalbano G, Casali G et al. Predicting long-term functional results after myocardial revascularization in ischemic cardiomyopathy. J Thorac Cardiovasc Surg 2000; 120(3): 478–489.

22. Eagle KA, Guyton RA, Davidoff R et al. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). Circulation 2004; 110(9): 1168–1176.

23. Wijns W, Kolh F, Danchin N et al. Guidelines on myocardial revascularization. The Task Force on Myocardial Revascularization of the European Society of Cardiology and the European Association for Cardio-Thoracic Surgery. Eur Heart J 2010; 31(20): 2501–2555.

24. Borger MA, Alam A, Muphy PM et al. Chronic ischemic mitral regurgitation: repair, replace or rething? Ann Thorac Surg 2006; 81(3): 1153–1161.

25. O´Connor CHM, Velazquez EJ, Gardner LH et al. Comparison of coronary artery bypass grafting versus medical therapy on long-term outcome in patients with ischemic cardiomyopathy (a 25-year experience from the Duke Cardiovascular Disease Databank). Am J Cardiol 2002; 90(2): 101–107.

26. Alderman EL, Fischer LD, Litwin P et al. Results of coronary artery surgery in patients with poor left ventricular function (CASS). Circulation 1983; 68(4): 785–795.

27. Cleland JG, Pennell DJ, Ray SG et al. Carvedilol Hibernating reversible ischaemia trial: marker of success invetigators: Myocardial viability as a determinant of the ejection fraction response to carvedilol in patients with heart failure (CHRISTMAS trial): randomised controlled trial. Lancet 2003; 362(9377): 14–21.

28. Lewis ME, Pitt MP, Bonser RS et al. Coronary artery surgery for ischaemic heart failure: the surgeons view. Heart Fail Rev 2003; 8(2): 175–179.

29. Rizzelo V, Poldermans D, Boersma E et al. Opposie patterns of left ventricular remodeling after coronary revascularization in patients with ischemic cardiomyopathy: role of mycardial viability. Circulation 2004; 110(16): 2383–2388.

30. Senior R, Kaul S, Lahiri A. Myocardial viability on echocardiography predicts long-term survival after revascularization in patients with ischemic congestive heart failure. J Am Coll Cardiol 1999; 33(7): 1848–1854.

31. Allman KC, Shaw LJ, Hachamovitch R et al. Myocardial viability testing and impact of revascularization on prognosis in patients with coronary artery disease and left ventricular dysfunction: a metaanalysis. J Am Coll Cardiol 2002; 39(7): 1151–1158.

32. Tarakji KG, Brunker R, McCarthy PM et al. Myocardial viability testing and the effect of early intervention in patients with advanced left ventricular systolic dysfunction. Circulation 2006; 113(2): 230–237.

33. Bax JJ, Schinkel AF, Boersma E et al. Extensive left ventricular remodeling does not allow viable myocardium to improve in left ventricular ejection fraction after revascularization and is associated with worse long-term prognosis. Circulation 2004; 110(11 Suppl 1): II18–22.

34. Schinkel AF, Poldermans D, Rizzello V et al. Why do patients with ischemic cardiomyopathy and a substantial amount of viable myocardium not always recover in function after revascularization? Thorac Cardiovasc Surg 2004; 127(2): 385–390.

35. Dor V, Saab M, Coste P et al. Left ventricular aneurysm: a new surgical approach. Thorac Cardiovasc Surg 1989; 37(1): 11–19.

36. Athanasuleas CI, Buckberg GD, Stanley AW et al. RESTORE group. Surgical ventricular restoration in the treatment of congestive heart failure due to post-infarction ventricular dilation. J Am Coll Cardiol 2004; 44(7): 1439–1445.

37. D’Egidio G, Nichol G, Williams KA et al.PARR-2 Investigators. Increasing benefit from revascularization is associated with increasing amounts of myocardial hibernation: a substudy of the PARR-2 trial. JACC Cardiovasc Imaging. 2009; 2(9): 1060–1068.

38. Cleland JGF, Calvert M, Freemantle N et al. The heart failure revascularisation trial (HEART). Eur J Heart Fail 2011; 13(2): 227–233.

39. Velazquez EJ, Lee KL, Deja MA et al. STICH Investigators. Coronary-artery bypass surgery in patients with left ventricular dysfunction. N Engl J Med 2011; 364(17): 1607–1616.

40. Doenst T, Cleland JG, Rouleau JL et al. STICH Investigators. Influence of crossover on mortality in a randomized study of revascularization in patients with systolic heart failure and coronary artery disease. Circ Heart Fail 2013; 6(3): 443–450.

41. Pron G. Coronary revascularization in ischemic heart failure patients: a rapid review. Toronto. Health Quality Ontario 2013. Dostupné z WWW: <>.

42. Jones RH, Velazquez EJ, Michler RE et al. for the STICH Hypothesis 2 Investigators. Coronary bypass surgery with or without surgical ventricular reconstruction. N Engl J Med 2009; 360(17): 1705–1717.

43. Shroyer ALW, Collins JF, Grover FL. Evaluating clinical applicability. J Am Coll Cardiol 2010; 56(6): 508–509.

44. Bonow RO, Maurer G, Lee KL et al. for the STICH Trial Investigators. Myocardial viability and survival in ischemic left ventricular dysfunction. N Engl J Med 2011; 364(17): 1617–1625.

45. Chareonthaitawee P, Gersh BJ, Panza JA. Is Viability Imaging Still Relevant in 2012? JACC Cardiovasc Imaging 2012; 5(5): 550–558.

46. McMurray JJV, Adamopoulos S, Anker SD et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Eur Heart J 2012; 33(14): 1787–1847.

47. Montalescot G, Sechtem U, Achenbach S et al. 2013 ESC guidelines on the management of stable coronary artery disease. The Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J 2013; 34(38): 2949–3003.

Diabetology Endocrinology Internal medicine
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account