Is Ventricular Reconstruction Effective for Heart Failure Patients?

Heart failure is a condition in which the heart is unable to supply sufficient blood flow to meet the body’s needs, and it often occurs after tissue is damaged by a heart attack. Generally, a person can develop heart failure because of myocardial infarction and other forms of ischemic heart disease, hypertension (high blood pressure), valvular heart disease and cardiomyopathy. About 5 million people in the United States are affected by heart failure.

When the heart fails, it will try to compensate for the damage by getting larger, but in the meantime, it will also pump much less efficiently. Ventricular reconstruction is an operation that is designed to help patients with heart failure. It involves folding the scarred portion of a damaged heart in on itself to get it to beat more effectively.

However, in a so-called STICH trial, doctors from Duke University Medical Center in North Carolina found that such operation provides no real benefit to most patients. Basing on work carried out at 96 medical centers in 23 countries, the findings were presented on March 29, 2009 at a meeting of the American College of Cardiology in Orlando and published in the New England Journal of Medicine.

During the STICH trial, doctors compared what happened to the 1,000 volunteers, who all got heart bypass operations, and half of them also got ventricular reconstruction. The results showed that ventricular reconstruction neither lowered the death rate or the risk of going back to the hospital nor improved the quality of life after 4 years.

No doubt, many patients have a lot fewer symptoms with the operation, but some patients could have the similar improvement with good medical treatment involving drugs. In fact, a patient will save an average of US$14,595 in the hospital costs, and the patient will spend one half hour less in the operating room.

Nevertheless, the operation is seldom carried out in the United States. In fact, only 3,000 to 5,000 such operations have been done worldwide in the last 10 years.

How is the Development of Fighting Heart Disease So Far?

During the last weekend of March 2009, heart specialists around the world gathered and met in Orlando, Florida for the 58th annual convention of the American College of Cardiology.

In the convention, these heart disease experts discussed major developments in fighting heart disease. The results of 31 clinical trials, which were divided into 6 sessions, were learned. Meanwhile, issues surrounding health care reform were also examined by a panel of economists and cardiologists.

In one session, the experts examined the results from the famous Jupiter trial, which were released during the late 2008. The trial revealed that Crestor, the world’s most popular anti-cholesterol medicine could actually lower the risk of heart disease by 44 percent.

In studying nearly 20,000 men and women aged 50 and above, the Jupiter trial found that controlled use of Crestor could reduce the combined risk of arterial revascularization, stroke and death from cardiovascular causes among patients who currently do not have a high risk of developing heart disease.

What interests the panels of experts is whether the results could be applied to millions of people without a high risk of cardiovascular disease but with elevated levels of C-reactive protein, which is a sign of artery inflammation.

There were 3 cardiologists who presented their analysis after examining on the data from Jupiter trial. Such trial is indeed an important one with so much data. In the meantime, the results of a survey of the organization’s 28,000 members on the Jupiter trial’s significance were also presented at the convention.

Another session looked at the results of the so-called STICH trial. This was a study carried out in 15 countries with an aim to determining what treatment or combinations of treatments works best for heart failure. Statistics does show that heart failure affects some 5 million Americans, mostly because of heart attack, hypertension (high blood pressure) or diabetes. The main purpose of the STICH trial was to assess the effectiveness of early surgery, as compared with other medical treatments, and then later surgical treatment if necessary.

The implications of the Heinz Nixdorf Recall study, which investigated the build-up of coronary artery calcium and the impact of Omega-3 fatty acids on cardiovascular disease, were discussed.