TY - JOUR
T1 - Regional left ventricular function does not predict survival in ischaemic cardiomyopathy after cardiac surgery
AU - Prior, David L.
AU - Stevens, Susanna R.
AU - Holly, Thomas A.
AU - Krejca, Michal
AU - Paraforos, Alexandros
AU - Pohost, Gerald M.
AU - Byrd, Krysti
AU - Kukulski, Tomasz
AU - Jones, Robert H.
AU - Desvigne-Nickens, Patrice
AU - Varadarajan, Padmini
AU - Amanullah, Aman
AU - Lin, Grace
AU - Al-Khalidi, Hussein R.
AU - Aldea, Gabriel
AU - Santambrogio, Carlo
AU - Bochenek, Andrzej
AU - Berman, Daniel S.
N1 - Publisher Copyright:
© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
PY - 2017
Y1 - 2017
N2 - 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.
AB - 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.
KW - coronary artery bypass grafting
KW - end-systolic volume index
KW - ischaemic cardiomyopathy
KW - randomised clinical trial
KW - surgical ventricular reconstruction
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U2 - 10.1136/heartjnl-2016-310693
DO - 10.1136/heartjnl-2016-310693
M3 - Article
C2 - 28446548
AN - SCOPUS:85027561602
SN - 1355-6037
VL - 103
SP - 1359
EP - 1367
JO - Heart
JF - Heart
IS - 17
ER -