Regional left ventricular function does not predict survival in ischaemic cardiomyopathy after cardiac surgery

David L. Prior, Susanna R. Stevens, Thomas A. Holly, Michal Krejca, Alexandros Paraforos, Gerald M. Pohost, Krysti Byrd, Tomasz Kukulski, Robert H. Jones, Patrice Desvigne-Nickens, Padmini Varadarajan, Aman Amanullah, Grace Lin, Hussein R. Al-Khalidi, Gabriel Aldea, Carlo Santambrogio, Andrzej Bochenek, Daniel S. Berman

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Objectives To define the prognostic contribution of global and regional left ventricular (LV) function measurements in patients with ischaemic cardiomyopathy randomised to coronary artery bypass graft surgery (CABG) with (n=501) or without (n=499) surgical ventricular reconstruction (SVR). Methods Novel multivariable methods to analyse global and regional LV systolic function were used to better formulate prediction models for long-term mortality following CABG with or without SVR in the entire cohort of 1000 randomised SVR hypothesis patients. Key clinical variables were included in the analysis. Regional function was classified according to the discreteness of anteroapical hypokinesia and akinesia into those most likely to benefit from SVR, those least likely and those felt to have intermediate likelihood of benefit from SVR. Results The most prognostic clinical variables identified in multivariable models include creatinine, LV end-systolic volume index (ESVI), age and NYHA (New York Heart Association) class. Addition of LV ejection fraction, LV end-diastolic volume index and regional function assessment did not contribute additional power to the model. Subgroup analysis based on regional function did not identify a cohort in which SVR improved mortality. Conclusions ESVI is the single parameter of LV function most predictive of mortality in patients with LV systolic dysfunction following CABG with or without SVR in multivariable models that include all key clinical and LV systolic function parameters. Assessment of regional cardiac function does not enhance prediction of mortality nor identify a subgroup for which SVR improves mortality. These results do not support elective addition of LV reconstruction surgery in patients undergoing CABG. Trial registration number NCT00023595.

Original languageEnglish (US)
Pages (from-to)1359-1367
Number of pages9
JournalHeart
Volume103
Issue number17
DOIs
StatePublished - 2017

Keywords

  • coronary artery bypass grafting
  • end-systolic volume index
  • ischaemic cardiomyopathy
  • randomised clinical trial
  • surgical ventricular reconstruction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Regional left ventricular function does not predict survival in ischaemic cardiomyopathy after cardiac surgery'. Together they form a unique fingerprint.

Cite this