Dormancy of a specialist herbivore, Anthonomus rufipennis (Coleoptera: Curculionidae), in a dry tropical forest.

The life history aspects of dormancy of the weevil Anthonomus rufipennis LeConte (Coleoptera: Curculionidae) were studied a 57-month period in a seasonally dry tropical forest of central Mexico. Weevil populations and their physiological status were monitored on both the reproductive host tree, Senna polyantha (Collad.) H.S: Irwin & Barneby (Fabales: Fabaceae) and the highly favored refuge host, Tillandsia recurvata L. (Poales: Bromeliaceae) or "ball moss." During the dry season, weevils were only found on the refuge host with a mean total density of 1.014 ± 2.532 individuals/ball moss (N = 1,681). Weevil densities on T. recurvata between early and late dry seasons were not significantly different, suggesting that dry season survival was relatively high. Weevils collected during these seasons revealed little reproductive development and relatively high-fat accumulation in both sexes. During 5 of 6 yr, densities of the weevils in T. recurvata dropped significantly during the early rainy seasons, when the reproductive host trees leafed out and began producing oviposition sites (flower buds). At this time, more males than females initially moved to vegetative trees and showed significant signs of reproductive development. Recolonization of ball moss by weevils began during the late rainy season when oviposition sites (flower buds) were still available. A proportion of the weevils remained on the reproductive host, suggesting that A. rufipennis is facultatively multivoltine. The methodologies and results of the study can serve as a model system for future studies of the dormancy of other insects in dry tropical forests and provide insight into the dormancy of other anthonomine weevils of economic importance.

A Qualitative Analysis of the Perceptions of Stakeholders Involved in Vector Control and Vector-Borne Disease Research and Surveillance in Orinoquia, Colombia.

Colombia has a tropical climate and environmental conditions that favour the circulation of most of the known vector-borne diseases (VBDs). Protocols have been established and implemented to address the threats of these diseases, but they are for country-wide use and do not take into consideration the nuances of the different environments of the country. Almost the entire population is vulnerable to infection with one or more VBD. This study aims to characterise the perceptions and experiences of stakeholders involved in vector control and VBDs in the Orinoquia region in Colombia. Two panel discussions, and 12 semi-structured interviews, were conducted. Experts from the Colombian National Health Institute (INS), health secretaries from Meta, Guaviare and Vichada Departments, academic researchers, and individuals from private vector control companies participated. All sessions were recorded, transcribed, and translated, and then subject to thematic analysis. Three major themes emerged: involvement, limitations, and recommendations. Results showed that participants are engaged in vector surveillance activities, education, and vector control research. Participants focused on problems of disjointed efforts towards VBD control between health secretaries and the health ministry, as well as societal issues, such as socioeconomic, cultural, and political issues, which became the rationale for the lack of vector control resources. Responses in the panel discussions and interviews overlapped in opinions, and suggested that vector control could be improved through better communication between vector control bodies, strengthened engagement with vulnerable communities, more collaborative actions, and a more balanced distribution of resources.

Trypanosoma cruzi and Leishmania spp. in rodents in a peri-urban area of Central Mexico.

Rodents are one of the most relevant groups of mammals involved in the process of zoonotic disease transmission. Their ability to adapt to anthropized environments allows them to come into contact with humans with often negative consequences for the latter. The present study designed to detect the presence of Trypanosoma cruzi and Leishmania spp. in rodents living in the peri-urban area of Queretaro in central Mexico. This research was carried out during two seasons of collection of wild and domestic rodents, in three localities within the peri-urban area of the state of Queretaro. These collections were carried out during the dry season of February-May 2017 and in the rainy season of August-November 2017. Samples were obtained from the tail tip, from which DNA was purified using the DNeasy Blood & Tissue Kit. End-point PCR was used for the identification of Trypanosoma cruzi and Leishmania spp. A total of 82 rodents were caught, represented in three families, six genera and seven species, of which 29 (35.3%) were positive for Trypanosoma cruzi; 13 (15.8%) for Leishmania spp.; and 12 individuals presented co-infection with both parasites (14.6%). This study confirmed the presence of Trypanosoma cruzi and Leishmania spp. in synanthropic rodents in the peri-urban area of Queretaro, where Chagas and Leishmaniosis diseases are not considered endemic. It is necessary to continue researching for the presence of vectors, as well as for the detection of diseases caused by parasites in humans and thus be able to confirm the transmission cycle of Trypanosoma cruzi and Leishmania spp. in this central Mexican city.

Potential Distribution of Wild Host Plants of the Boll Weevil (Anthonomus grandis) in the United States and Mexico

The boll weevil (Anthonomus grandis Boheman) reproduces on a reported 13 species of wild host plants in North America, two in the United States and 12 in Mexico. The distributions of these plants are of economic importance to pest management and provide insight into the evolutionary history and origin of the BW. However, detailed information regarding the distributions of many of these species is lacking. In this article, we present distribution models for all of the reported significant BW host plants from Mexico and the United States using spatial distribution modelling software. Host plant distributions were divided into two groups: "eastern" and "western." In Mexico, Hampea nutricia along the Gulf Coast was the most important of the eastern group, and the wild cottons, Gossypium aridum and Gossypium thurberi were most important in the western group. Other species of Hampea, Gossypium, and Cienfuegosia rosei have relatively restricted distributions and are of apparent minimal economic importance. Cienfuegosia drummondii is the only truly wild host in the southern United States, east of New Mexico. Factors determining potential distributions were variable and indicated that species were present in five vegetation types. Ecological and economic considerations of host plant distributions are discussed, as well as threats to host plant conservation.

Vector control strategies in Brazil: a qualitative investigation into community knowledge, attitudes and perceptions following the 2015-2016 Zika virus epidemic.

OBJECTIVE: The World Health Organization declared a Public Health Emergency of International Concern following the rapid emergence of neonatal microcephaly in Brazil during the 2015-2016 Zika virus (ZIKV) epidemic. In response, a national campaign sought to control Aedes mosquito populations and reduce ZIKV transmission. Achieving adherence to vector control or mosquito-bite reduction behaviours, including the use of topical mosquito repellents, is challenging. Coproduction of research at the community level is needed to understand and mitigate social determinants of lower engagement with Aedes preventive measures, particularly within disempowered groups. DESIGN: In 2017, the Zika Preparedness Latin America Network (ZikaPLAN) conducted a qualitative study to understand individual and community level experiences of ZIKV and other mosquito-borne disease outbreaks. Presented here is a thematic analysis of 33 transcripts from community focus groups and semistructured interviews, applying the Health Belief Model (HBM) to elaborate knowledge, attitudes and perceptions of ZIKV and vector control strategies. PARTICIPANTS: 120 purposively sampled adults of approximate reproductive age (18-45); 103 women participated in focus groups and 17 men in semistructured interviews. SETTING: Two sociopolitically and epidemiologically distinct cities in Brazil: Jundiaí (57 km north of São Paolo) and Salvador (Bahia state capital). RESULTS: Four key and 12 major themes emerged from the analysis: (1) knowledge and cues to action; (2) attitudes and normative beliefs (perceived threat, barriers, benefits and self-efficacy); (3) behaviour change (household prevention and community participation); and (4) community preferences for novel repellent tools, vector control strategies and ZIKV messaging. CONCLUSIONS: Common barriers to repellent adherence were accessibility, appearance and effectiveness. A strong case is made for the transferability of the HBM to inform epidemic preparedness for mosquito-borne disease outbreaks at the community level. Nationally, a health campaign targeting men is recommended, in addition to local mobilisation of funding to strengthen surveillance, risk communication and community engagement.

Gap Analysis of the Habitat Interface of Ticks and Wildlife in Mexico.

Mexico is a highly diverse country where ticks and tick-borne diseases (TBD) directly impact the health of humans and domestic and wild animals. Ticks of the genera Rhipicephalus spp., Amblyomma spp., and Ixodes spp. represent the most important species in terms of host parasitism and geographical distribution in the country, although information on other genera is either limited or null. In addition, information regarding the influence of global warming on the increase in tick populations is scarce or nonexistent, despite climate conditions being the most important factors that determine tick distribution. In order to aid in the management of ticks and the risks of TBD in humans and domestic animals in Mexico, an analysis was conducted of the gaps in information on ticks with the purpose of updating the available knowledge of these ectoparasites and adapting the existing diagnostic tools for potential distribution analysis of TBD in wildlife. These tools will help to determine the epidemiological role of wildlife in the human-domestic animal interface in anthropized environments in Mexico.

Public health messages on arboviruses transmitted by Aedes aegypti in Brazil.

BACKGROUND: The outbreak of Zika virus in Brazil in 2015 followed the arrival of chikungunya in 2014 and a long history of dengue circulation. Vital to the response to these outbreaks of mosquito-borne pathogens has been the dissemination of public health messages, including those promoted through risk communication posters. This study explores the content of a sample of posters circulated in Brazil towards the end of the Zika epidemic in 2017 and analyses their potential effectiveness in inducing behaviour change. METHODS: A content analysis was performed on 37 posters produced in Brazil to address outbreaks of mosquito-borne pathogens. The six variables of the Health Belief Model were used to assess the potential effectiveness of the posters to induce behaviour change. RESULTS: Three overarching key messages emerged from the posters. These included (i) the arboviruses and their outcomes, (ii) a battle against the mosquito, and (iii) a responsibility to protect and prevent. Among the six variables utilised through the Health Belief Model, cues to action were most commonly featured, whilst the perceived benefits of engaging in behaviours to prevent arbovirus transmission were the least commonly featured. CONCLUSIONS: The posters largely focused on mosquito-borne transmission and the need to eliminate breeding sites, and neglected the risk of the sexual and congenital transmission of Zika and the importance of alternative preventive actions. This, we argue, may have limited the potential effectiveness of these posters to induce behaviour change.

An investigation into the knowledge, perceptions and role of personal protective technologies in Zika prevention in Colombia.

BACKGROUND: Arboviruses transmitted by day-biting Aedes mosquitoes are a major public health concern. With the challenges inherent in arbovirus vaccine and therapeutics development, vector control and bite prevention strategies are among the limited options available for immediate intervention. Bite prevention through personal protective technologies (PPT), such as topical mosquito repellents or repellent-impregnated clothing, may help to decrease biting rates and, therefore, the risk of disease in groups most susceptible to adverse outcomes from Zika virus. However, achieving high uptake and compliance with PPT can be challenging. METHODOLOGY/PRINCIPAL FINDINGS: To gain an insight into the knowledge and concerns of pregnant women surrounding Zika and their opinions regarding PPT, particularly repellent clothing, a focus group study was carried out with pregnant women, women of reproductive age, and semi-structured interviews with their male partners in two cities in Colombia. The discussions revealed shortfalls in basic knowledge of Zika virus, with several pregnant participants reporting being unaware of the potential for Zika-related congenital malformations. Although participants generally considered Zika to be a significant personal threat, most rated it as less of a concern than dengue or diarrheal diseases. Overall, repellent clothing and other forms of PPT were viewed as effective, although some participants expressed concerns over the high costs of repellents, and safety fears of regular contact with repellent chemicals, which they perceived as potentially harmful. Plant-derived repellents were considered to be safer than synthetic chemical repellents. Discussions also highlighted that health centers were the preferred source of information on bite-reduction. CONCLUSIONS/SIGNIFICANCE: Achieving high uptake and compliance with PPT in populations most at risk of adverse outcomes from Zika infection requires engaging key users in open dialogue to identify and address any practical issues regarding PPT use, and concerns over safety. The findings presented here suggest that educational campaigns should strongly emphasize the risks associated with Zika during pregnancy, and discuss safety profiles of approved synthetic repellents and the availability of EPA-approved plant-based repellents. In addition, the economic and political context should be a major consideration when evaluating personal mosquito-repellent strategies.

Faunistic patterns of leaf beetles (Coleoptera, Chrysomelidae) within elevational and temporal gradients in Sierra de San Carlos, Mexico.

The study of biodiversity of Chrysomelidae in Mexico and its variation within ecological gradients has increased recently, although important areas in the country remain to be explored. We conducted a faunistic inventory and analyzed the elevational and temporal variation of leaf beetle communities in the Sierra de San Carlos, in the state of Tamaulipas, in northeastern Mexico. This is an area with high to extreme priority for conservation, and due to its insular geographical position and to the vegetational communities present, it must be considered as a sky island. We selected seven sample sites distributed in different elevations within three localities, and comprising different vegetational communities. At each site, we randomly delimited 12 sample plots of 400 m(2) where sampling was conducted by entomological sweep netting and collecting directly by hand. Sampling was conducted monthly at each plot, for a total of 1,008 samples between February 2013 and January 2014. By the end of the study, we had obtained a total of 3,081 specimens belonging to six subfamilies, 65 genera, and 113 species, with Trichaltica scabricula (Crotch, 1873) being recorded for first time in Mexico. Species richness was less than the values observed at other studies conducted in the same region, which is attributed to differences in the number of plant species and to the insular location of Sierra de San Carlos; however, the higher diversity values suggest a higher quality of natural resources and vegetational communities. No consistent pattern of leaf beetle communities was correlated with elevation, although higher values of species richness and diversity were obtained at the highest elevation site. The seasonal gradient showed that the rainy season is most favorable for leaf beetle communities. We found that species composition was different between sites and months, and also that there exists a significant association between the abundance obtained at each site and particular months. These results highlight the importance of different microhabitats for species distribution, and suggest that each species of Chrysomelidae has a differential response to environmental factors that vary within the elevational gradient and according to seasons. Also, we confirm and emphasize the important status of Sierra de San Carlos as a key natural area for biological conservation.

Gray fox (Urocyon cinereoargenteus) parasite diversity in central Mexico.

Mexico has a long history of parasitological studies in communities of vertebrates. However, the mega diversity of the country makes fauna inventories an ongoing priority. Presently, there is little published on the parasite fauna of gray foxes (Urocyon cinereoargenteus Schereber, 1775) and this study provides new records of parasites for gray foxes in central Mexico. It is a continuation of a series of previous parasitological studies conducted with this carnivore in Mexico from 2003 to the present. A total of 24 foxes in the Parque Nacional El Cimatario (PANEC) were trapped, anaesthetized, and parasites recovered. The species found were Dirofilaria immitis, Ctenocephalides canis, C. felis, Euhoplopsillus glacialis affinis (first report for gray foxes in Mexico) Pulex simulants, and Ixodes sp. Three additional gray fox carcasses were necropsied and the parasites collected were adult nematodes Physaloptera praeputialis and Toxocara canis. The intensive study of the gray fox population selected for the 2013-2015 recent period allowed for a two-fold increase in the number of parasite species recorded for this carnivore since 2003 (nine to 18 parasite species), mainly recording parasitic arthropods, Dirofilaria immitis filariae and adult nematodes. The parasite species recorded are generalists that can survive in anthropic environments; which is characteristic of the present ecological scenario in central Mexico. The close proximity of the PANEC to the city of Santiago de Queretaro suggests possible parasite transmission between the foxes and domestic and feral dogs. Furthermore, packs of feral dogs in the PANEC might have altered habitat use by foxes, with possible impacts on transmission.

Checklist of leaf beetles (Coleoptera: Chrysomelidae) from the state of Morelos, Mexico.

We record 116 genera and 366 species of Chrysomelidae from the state of Morelos, Mexico. This represents an increase of 9.3% in the species richness of these beetles for the state. Also, Morelos is currently the third most diverse state in leaf beetles within Mexico, with 16.78% of total species recorded for the country. The most diverse genera were Calligrapha, Disonycha, Blepharida, Leptinotarsa, Cryptocephalus, Systena, Alagoasa, Diabrotica and Pachybrachis, each with more than eight species. Most of these genera contain large, showy beetles. When the chrysomelid fauna is more fully understood, some of the genera of tiny beetles will likely prove to be more diverse.

Presence of trypanosomatid antibodies in gray foxes (Urocyon cinereoargenteus) and domestic and feral dogs (Canis lupus familiaris) in Queretaro, Mexico.

Trypanosoma cruzi and Leishmania spp. are vector-borne parasitic protozoa, the causative agents of Chagas and Leishmaniasis diseases, respectively. Trypanosoma cruzi and Leishmania spp. have been reported in a wide variety of mammals, including canids, which play an important role in the transmission of these parasites between urban and natural environments. Currently, no studies have been conducted on trypanosomatids in wild canids in Mexico. Using a partially purified fraction of excreted Iron Superoxide dismutase (FeSODe) of T. cruzi, L. mexicana, and L. infantum as antigen for the ELISA and Western blot tests, we detected the presence of antibodies against these parasites in gray foxes (Urocyon cinereoargenteus Schreber, 1775), domestic and feral dogs (Canis lupus familiaris L.) from Queretaro. Our study provides new information regarding the potential of these carnivores as reservoirs of T. cruzi, Leishmania mexicana, and L. infantum for Latin America.

Diversity and altitudinal distribution of Chrysomelidae (Coleoptera) in Peregrina Canyon, Tamaulipas, Mexico.

The Chrysomelidae (Coleoptera) is a highly speciose family that has been poorly studied at the regional level in Mexico. In the present study, we estimated species richness and diversity in oak-pine forest, Tamaulipan thorny scrub and in tropical deciduous forests in Peregrina Canyon within the Altas Cumbres Protected Area of the northeastern state of Tamaulipas, Mexico. Sampling of Chrysomelidae consisted of five sweep net samples (200 net sweeps) within each of three sites during four sample periods: early dry season, late dry season, early wet season, and late wet season. Species were identified and total numbers per species were recorded for each sample. A total of 2,226 specimens were collected belonging to six subfamilies, 81 genera and 157 species of Chrysomelidae from the study area. Galerucinae was the most abundant subfamily with 1,828 specimens, representing 82.1% of total abundance in the study area. Lower abundance was recorded in Cassidinae (8.5%), Eumolpinae (3.6%), Cryptocephalinae (2.2%), Chrysomelinae (2.2%), and finally Criocerinae (1.3%). The highest species richness was also presented in the subfamily Galerucinae with 49% of the total obtained species followed by Cassidinae (20%), Cryptocephalinae (9.7%), Eumolpinae (9.7%), Chrysomelinae (6.5%) and Criocerinae (5.2%). The most common species were Centralaphthona fulvipennis Jacoby (412 individuals), Centralaphthona diversa (Baly) (248), Margaridisa sp.1 (219), Acallepitrix sp.1 (134), Longitarsus sp.1 (104), Heterispa vinula (Erichson) (91), Epitrix sp.1 (84) and Chaetocnema sp.1 (72). Twenty-two species were doubletons (1.97% of total abundance) and 52 were singletons (2.33%). The estimated overall density value obtained was 0.0037 individuals/m2. The greatest abundance and density of individuals were recorded at the lowest elevation site. However, alpha diversity increased with increasing altitude. Similarity values were less than 50% among the three sites indicating that each site had distinct species assemblages of Chrysomelidae. The highest abundance was obtained during the late dry season, whereas diversity indices were highest during the early wet season. The present work represents the first report of the altitudinal variation in richness, abundance, and diversity of Chrysomelidae in Mexico. These results highlight the importance of conservation of this heterogeneous habitat and establish baseline data for Chrysomelidae richness and diversity for the region.

Ophiuroidea (Echinodermata) from coral reefs in the Mexican Pacific.

There are numerous and important coral reefs in the Mexican Pacific, but scarce studies of brittle stars conducted in these ecosystems. In this regard, this work provides the first annotated checklist of brittle stars associated with coral communities and reefs in the Mexican Pacific and an illustrated key to identify the species. We also provide taxonomic descriptions, spatial and bathymetric distributions and some important remarks of the species. We report a total of 14 species of brittle stars belonging to nine genera and seven families. Ophiocnida hispida in Jalisco, Ophiophragmus papillatus in Guerrero, and Ophiothrix (Ophiothrix) spiculata and Ophiactis simplex in Colima are new distribution records. The record of O. papillatus is remarkable because the species has not been reported since its description in 1940. The brittle stars collected in this study, represent 22.2% of the total species previously reported from the Mexican Pacific. Presently, anthropogenic activities on the coral reefs of the Mexican Pacific have increased, thus the biodiversity of brittle stars in these ecosystems may be threatened.

A taxonomic monograph of the genus Tylodinus Champion (Coleoptera: Curculionidae: Cryptorhynchinae: Tylodina) of Chiapas, Mexico.

The species of the genus Tylodinus from the Mexican state of Chiapas are revised. We examined 989 specimens representing 36 species; 23 species are grouped into eight species groups with 13 species considered as Incertae sedis. A total of 32 species are described as new and one species is a new record for México. Species groups  (numbers of species in parentheses) and species are: Tylodinus buchanani species group (6) T. buchanani new species (type locality: Chiapas, Unión Juárez, Volcán Tacan), T. exiguus new species (type locality: Chiapas, Motozintla, 7 km SSW Motozintla de Mendoza), T. ixchel new species (type locality: Chiapas, Unión Juarez, Volcán Tacan), T. jonesi new species (type locality: Chiapas, Angel Albino Corzo, Reserva de la Biosfera el Triunfo, Campamento el Quetzal), T. variabilis new species (type locality: Chiapas, San Cristóbal de las Casas, Cerro Huitepec), T. wibmeri new species (type locality: Chiapas, Motozintla, 7 km SSW Motozintla de Mendoza); Tylodinus canaliculatus species group (3) T. canaliculatus Champion (Chiapas, Unión Juárez, Volcán Tacan, new record for  México), T. sepulturaensis new species (Type locality: Chiapas, Villa Corzo, Ejido Sierra Morena), T. triumforium new species (Type locality: Chiapas, La Concordia, 4 km SE Custepec); Tylodinus cavicrus species group (3) T. cavicrus Champion, T. pseudocavicrus new species (type locality: Chiapas, San Cristóbal de las Casas, Cerro Huitepec), T. rugosus new species (type locality: Chiapas, Villa Flores, Sierra Morena); Tylodinus coapillensis species group (2) T. coapillensis new species (type locality: Chiapas, Coapilla, ca. 10.5 km NE Coapilla), T. leoncortesi new species (type locality: Chiapas, Pueblo Nuevo Solistahuacán, La Yerbabuena); Tylodinus mutabilis species group (2) Tylodinus mutabilis new species (type locality: Chiapas, Villa Corzo, Ejido Sierra Morena), T. parvus new species (type locality: Chiapas, Trinitaria, Lagunas de Montebello); Tylodinus nodulosus species group (3) T. andersoni new species (Chiapas, Ángel Albino Corzo, Reserva El Triunfo, Polígono 1), T. nodulosus (Boheman), T. zilchi Kuschel; Tylodinus pusillus species group (2) T. porvenirensis new species (type locality: Chiapas, El Porvenir, El Porvenir (2 km NE)), T. pusillus new species (type locality: Chiapas, 4 km SE Custepec); Tylodinus spiniventris species group (2) T. lum new species (Chiapas, San Cristóbal de las Casas, Cerro Huitepec), and T. spiniventris new species (type locality: Chiapas, San Cristóbal de las Casas, Reserva Huitepec); Incertae sedis (13) T. pinguis new species (type locality: Chiapas, Ángel Albino Corzo, Reserva El Triunfo, Polígono 1) , T. kissingeri new species (type locality: Chiapas, Tapalapa, ca. 14 km NE Coapilla), T. complicatus new species (type locality: Chiapas, Pueblo Nuevo Solistahuacán, La Yerbabuena), T. dominicus new species (type locality: Chiapas, Villa Corzo, Reserva de la Biósfera La Sepultura), T. noctis new species (type locality: Chiapas, Coapilla, ca. 10.5 km NE Coapilla), T. rufus new species (type locality: Chiapas, San Cristóbal de las Casas, Cerro Huitepec); T. branstetteri new species (type locality: Chiapas, La Concordia, 4 km SE Custepec), T. kuscheli new species (type locality: Chiapas, Villa Flores, Ejido Sierra Morena), T. pappi new species (type locality: Chiapas, Unión Juárez, Volcán Tacan), T. gibbosus new species (type locality: Chiapas, Pueblo Nuevo Solistahuacán, Yerbabuena Reserve), T. immundus new species (type locality: Chiapas, San Cristóbal de las Casas Cerro Huitepec), T. intzin new species (type locality: Chiapas, Tenejapa, Yashanal), T. elongatus new species (type locality: Chiapas, Ángel Albino Corzo, Reserva El Triunfo, Polígono 1). Three species (T. nodulosus (Boheman), T. zilchi Kuschel and T. cavicrus Champion) are not known to occur in Chiapas but were included in this study to be more representative of inter- and intraspecific variation and to provide a better definition of the taxonomic limits of species and species groups.        Species groups are characterized and taxonomic composition and general distribution and ecological correlates summarized. Diagnoses and distributions are given for all species and ecological information is presented where available. Immature stages, life history and food habits are not known for any of the species. 

Myocardial viability and impact of surgical ventricular reconstructionon outcomes of patients with severe left ventricular dysfunctionundergoing coronary artery bypass surgery: results of the surgical treatment for ischemic heart failure trial

Objectives: In the Surgical Treatment for Ischemic Heart Failure trial, surgical ventricular reconstruction pluscoronary artery bypass surgery was not associated with a reduction in the rate of death or cardiac hospitalizationcompared with bypass alone. We hypothesized that the absence of viable myocardium identifies patients withcoronary artery disease and left ventricular dysfunction who have a greater benefit with coronary artery bypassgraft surgery and surgical ventricular reconstruction compared with bypass alone.Methods: Myocardial viability was assessed by single photon computed tomography in 267 of the 1000 patientsrandomized to bypass or bypass plus surgical ventricular reconstruction in the Surgical Treatment for IschemicHeart Failure. Myocardial viability was assessed on a per patient basis and regionally according to prespecifiedcriteria.Results: At 3 years, there was no difference in mortality or the combined outcome of death or cardiachospitalization between those with and without viability, and there was no significant interaction between thetype of surgery and the global viability status with respect to mortality or death plus cardiac hospitalization.Furthermore, there was no difference in mortality or death plus cardiac hospitalization between those withand without anterior wall or apical scar, and no significant interaction between the presence of scar in theseregions and the type of surgery with respect to mortality.Conclusions: In patients with coronary artery disease and severe regional left ventricular dysfunction,assessment of myocardial viability does not identify patients who will derive a mortality benefit from addingsurgical ventricular reconstruction to coronary artery bypass graft surgery.

Myocardial viability and impact of surgical ventricular reconstruction on outcomes of patients with severe left ventricular dysfunction undergoing coronary artery bypass surgery: results of the surgical treatment for ischemic heart failure trial

In the Surgical Treatment for Ischemic Heart Failure trial, surgical ventricular reconstruction plus coronary artery bypass surgery was not associated with a reduction in the rate of death or cardiac hospitalization compared with bypass alone. We hypothesized that the absence of viable myocardium identifies patients with coronary artery disease and left ventricular dysfunction who have a greater benefit with coronary artery bypass graft surgery and surgical ventricular reconstruction compared with bypass alone.MethodsMyocardial viability was assessed by single photon computed tomography in 267 of the 1000 patients randomized to bypass or bypass plus surgical ventricular reconstruction in the Surgical Treatment for Ischemic Heart Failure. Myocardial viability was assessed on a per patient basis and regionally according to prespecified criteria.ResultsAt 3 years, there was no difference in mortality or the combined outcome of death or cardiac hospitalization between those with and without viability, and there was no significant interaction between the type of surgery and the global viability status with respect to mortality or death plus cardiac hospitalization. Furthermore, there was no difference in mortality or death plus cardiac hospitalization between those with and without anterior wall or apical scar, and no significant interaction between the presence of scar in these regions and the type of surgery with respect to mortality.ConclusionsIn patients with coronary artery disease and severe regional left ventricular dysfunction, assessment of myocardial viability does not identify patients who will derive a mortality benefit from adding surgical ventricular reconstruction to coronary artery bypass graft surgery.