Implication of right ventricular dysfunction on long-term outcome in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting with or without surgical ventricular reconstruction

Tomasz Kukulski, Lilin She, Normand Racine, Sinisa Gradinac, Julio A. Panza, Eric J. Velazquez, Kwan Chan, Mark C. Petrie, Kerry L. Lee, Patricia Pellikka, Alexander Romanov, Jolanta Biernat, Jean L. Rouleau, Carmen Batlle, Jan Rogowski, Paolo Ferrazzi, Marian Zembala, Jae Kuen Oh

Research output: Contribution to journalArticle

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Abstract

Objective Whether right ventricular dysfunction affects clinical outcome after coronary artery bypass grafting with or without surgical ventricular reconstruction is still unknown. The aim of the study was to assess the impact of right ventricular dysfunction on clinical outcome in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting with or without surgical ventricular reconstruction. Methods Of 1000 patients in the Surgical Treatment for Ischemic Heart Failure with coronary artery disease, left ventricular ejection fraction 35% or less, and anterior dysfunction, who were randomized to undergo coronary artery bypass grafting or coronary artery bypass grafting + surgical ventricular reconstruction, baseline right ventricular function could be assessed by echocardiography in 866 patients. Patients were followed for a median of 48 months. All-cause mortality or cardiovascular hospitalization was the primary end point, and all-cause mortality alone was a secondary end point. Results Right ventricular dysfunction was mild in 102 patients (12%) and moderate or severe in 78 patients (9%). Moderate to severe right ventricular dysfunction was associated with a larger left ventricle, lower ejection fraction, more severe mitral regurgitation, higher filling pressure, and higher pulmonary artery systolic pressure (all P <.0001) compared with normal or mildly reduced right ventricular function. A significant interaction between right ventricular dysfunction and treatment allocation was observed. Patients with moderate or severe right ventricular dysfunction who received coronary artery bypass grafting + surgical ventricular reconstruction had significantly worse outcomes compared with patients who received coronary artery bypass grafting alone on both the primary (hazard ratio, 1.86; confidence interval, 1.06-3.26; P = .028) and the secondary (hazard ratio, 3.37; confidence interval, 1.36-8.37; P = .005) end points. After adjusting for all other prognostic clinical factors, the interaction remained significant with respect to all-cause mortality (P = .022). Conclusions Adding surgical ventricular reconstruction to coronary artery bypass grafting may worsen long-term survival in patients with ischemic cardiomyopathy with moderate to severe right ventricular dysfunction, which reflects advanced left ventricular remodeling.

Original languageEnglish (US)
Article number9008
Pages (from-to)1312-1321
Number of pages10
JournalJournal of Thoracic and Cardiovascular Surgery
Volume149
Issue number5
DOIs
StatePublished - May 1 2015

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Right Ventricular Dysfunction
Cardiomyopathies
Coronary Artery Bypass
Right Ventricular Function
Mortality
Confidence Intervals
Ventricular Remodeling
Mitral Valve Insufficiency
Stroke Volume
Pulmonary Artery
Heart Ventricles
Echocardiography
Coronary Artery Disease
Hospitalization
Heart Failure
Blood Pressure
Pressure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

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Implication of right ventricular dysfunction on long-term outcome in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting with or without surgical ventricular reconstruction. / Kukulski, Tomasz; She, Lilin; Racine, Normand; Gradinac, Sinisa; Panza, Julio A.; Velazquez, Eric J.; Chan, Kwan; Petrie, Mark C.; Lee, Kerry L.; Pellikka, Patricia; Romanov, Alexander; Biernat, Jolanta; Rouleau, Jean L.; Batlle, Carmen; Rogowski, Jan; Ferrazzi, Paolo; Zembala, Marian; Oh, Jae Kuen.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 149, No. 5, 9008, 01.05.2015, p. 1312-1321.

Research output: Contribution to journalArticle

Kukulski, T, She, L, Racine, N, Gradinac, S, Panza, JA, Velazquez, EJ, Chan, K, Petrie, MC, Lee, KL, Pellikka, P, Romanov, A, Biernat, J, Rouleau, JL, Batlle, C, Rogowski, J, Ferrazzi, P, Zembala, M & Oh, JK 2015, 'Implication of right ventricular dysfunction on long-term outcome in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting with or without surgical ventricular reconstruction', Journal of Thoracic and Cardiovascular Surgery, vol. 149, no. 5, 9008, pp. 1312-1321. https://doi.org/10.1016/j.jtcvs.2014.09.117
Kukulski, Tomasz ; She, Lilin ; Racine, Normand ; Gradinac, Sinisa ; Panza, Julio A. ; Velazquez, Eric J. ; Chan, Kwan ; Petrie, Mark C. ; Lee, Kerry L. ; Pellikka, Patricia ; Romanov, Alexander ; Biernat, Jolanta ; Rouleau, Jean L. ; Batlle, Carmen ; Rogowski, Jan ; Ferrazzi, Paolo ; Zembala, Marian ; Oh, Jae Kuen. / Implication of right ventricular dysfunction on long-term outcome in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting with or without surgical ventricular reconstruction. In: Journal of Thoracic and Cardiovascular Surgery. 2015 ; Vol. 149, No. 5. pp. 1312-1321.
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abstract = "Objective Whether right ventricular dysfunction affects clinical outcome after coronary artery bypass grafting with or without surgical ventricular reconstruction is still unknown. The aim of the study was to assess the impact of right ventricular dysfunction on clinical outcome in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting with or without surgical ventricular reconstruction. Methods Of 1000 patients in the Surgical Treatment for Ischemic Heart Failure with coronary artery disease, left ventricular ejection fraction 35{\%} or less, and anterior dysfunction, who were randomized to undergo coronary artery bypass grafting or coronary artery bypass grafting + surgical ventricular reconstruction, baseline right ventricular function could be assessed by echocardiography in 866 patients. Patients were followed for a median of 48 months. All-cause mortality or cardiovascular hospitalization was the primary end point, and all-cause mortality alone was a secondary end point. Results Right ventricular dysfunction was mild in 102 patients (12{\%}) and moderate or severe in 78 patients (9{\%}). Moderate to severe right ventricular dysfunction was associated with a larger left ventricle, lower ejection fraction, more severe mitral regurgitation, higher filling pressure, and higher pulmonary artery systolic pressure (all P <.0001) compared with normal or mildly reduced right ventricular function. A significant interaction between right ventricular dysfunction and treatment allocation was observed. Patients with moderate or severe right ventricular dysfunction who received coronary artery bypass grafting + surgical ventricular reconstruction had significantly worse outcomes compared with patients who received coronary artery bypass grafting alone on both the primary (hazard ratio, 1.86; confidence interval, 1.06-3.26; P = .028) and the secondary (hazard ratio, 3.37; confidence interval, 1.36-8.37; P = .005) end points. After adjusting for all other prognostic clinical factors, the interaction remained significant with respect to all-cause mortality (P = .022). Conclusions Adding surgical ventricular reconstruction to coronary artery bypass grafting may worsen long-term survival in patients with ischemic cardiomyopathy with moderate to severe right ventricular dysfunction, which reflects advanced left ventricular remodeling.",
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T1 - Implication of right ventricular dysfunction on long-term outcome in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting with or without surgical ventricular reconstruction

AU - Kukulski, Tomasz

AU - She, Lilin

AU - Racine, Normand

AU - Gradinac, Sinisa

AU - Panza, Julio A.

AU - Velazquez, Eric J.

AU - Chan, Kwan

AU - Petrie, Mark C.

AU - Lee, Kerry L.

AU - Pellikka, Patricia

AU - Romanov, Alexander

AU - Biernat, Jolanta

AU - Rouleau, Jean L.

AU - Batlle, Carmen

AU - Rogowski, Jan

AU - Ferrazzi, Paolo

AU - Zembala, Marian

AU - Oh, Jae Kuen

PY - 2015/5/1

Y1 - 2015/5/1

N2 - Objective Whether right ventricular dysfunction affects clinical outcome after coronary artery bypass grafting with or without surgical ventricular reconstruction is still unknown. The aim of the study was to assess the impact of right ventricular dysfunction on clinical outcome in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting with or without surgical ventricular reconstruction. Methods Of 1000 patients in the Surgical Treatment for Ischemic Heart Failure with coronary artery disease, left ventricular ejection fraction 35% or less, and anterior dysfunction, who were randomized to undergo coronary artery bypass grafting or coronary artery bypass grafting + surgical ventricular reconstruction, baseline right ventricular function could be assessed by echocardiography in 866 patients. Patients were followed for a median of 48 months. All-cause mortality or cardiovascular hospitalization was the primary end point, and all-cause mortality alone was a secondary end point. Results Right ventricular dysfunction was mild in 102 patients (12%) and moderate or severe in 78 patients (9%). Moderate to severe right ventricular dysfunction was associated with a larger left ventricle, lower ejection fraction, more severe mitral regurgitation, higher filling pressure, and higher pulmonary artery systolic pressure (all P <.0001) compared with normal or mildly reduced right ventricular function. A significant interaction between right ventricular dysfunction and treatment allocation was observed. Patients with moderate or severe right ventricular dysfunction who received coronary artery bypass grafting + surgical ventricular reconstruction had significantly worse outcomes compared with patients who received coronary artery bypass grafting alone on both the primary (hazard ratio, 1.86; confidence interval, 1.06-3.26; P = .028) and the secondary (hazard ratio, 3.37; confidence interval, 1.36-8.37; P = .005) end points. After adjusting for all other prognostic clinical factors, the interaction remained significant with respect to all-cause mortality (P = .022). Conclusions Adding surgical ventricular reconstruction to coronary artery bypass grafting may worsen long-term survival in patients with ischemic cardiomyopathy with moderate to severe right ventricular dysfunction, which reflects advanced left ventricular remodeling.

AB - Objective Whether right ventricular dysfunction affects clinical outcome after coronary artery bypass grafting with or without surgical ventricular reconstruction is still unknown. The aim of the study was to assess the impact of right ventricular dysfunction on clinical outcome in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting with or without surgical ventricular reconstruction. Methods Of 1000 patients in the Surgical Treatment for Ischemic Heart Failure with coronary artery disease, left ventricular ejection fraction 35% or less, and anterior dysfunction, who were randomized to undergo coronary artery bypass grafting or coronary artery bypass grafting + surgical ventricular reconstruction, baseline right ventricular function could be assessed by echocardiography in 866 patients. Patients were followed for a median of 48 months. All-cause mortality or cardiovascular hospitalization was the primary end point, and all-cause mortality alone was a secondary end point. Results Right ventricular dysfunction was mild in 102 patients (12%) and moderate or severe in 78 patients (9%). Moderate to severe right ventricular dysfunction was associated with a larger left ventricle, lower ejection fraction, more severe mitral regurgitation, higher filling pressure, and higher pulmonary artery systolic pressure (all P <.0001) compared with normal or mildly reduced right ventricular function. A significant interaction between right ventricular dysfunction and treatment allocation was observed. Patients with moderate or severe right ventricular dysfunction who received coronary artery bypass grafting + surgical ventricular reconstruction had significantly worse outcomes compared with patients who received coronary artery bypass grafting alone on both the primary (hazard ratio, 1.86; confidence interval, 1.06-3.26; P = .028) and the secondary (hazard ratio, 3.37; confidence interval, 1.36-8.37; P = .005) end points. After adjusting for all other prognostic clinical factors, the interaction remained significant with respect to all-cause mortality (P = .022). Conclusions Adding surgical ventricular reconstruction to coronary artery bypass grafting may worsen long-term survival in patients with ischemic cardiomyopathy with moderate to severe right ventricular dysfunction, which reflects advanced left ventricular remodeling.

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