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Effects of myocardial viability and left ventricular remodeling on survival of patients with heart failure and reduced ejection fraction after coronary artery bypass grafting.

Authors
  • Cao, Jian1
  • Dong, Ran1
  • Zhang, Kui1
  • Zhang, Hongjia1, 2, 3
  • 1 Department of Cardiac Surgery, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China. , (China)
  • 2 Beijing Lab for Cardiovascular Precision Medicine, Beijing 100029, China. , (China)
  • 3 Beijing Engineering Research Center for Vascular Prostheses, Beijing 100029, China. , (China)
Type
Published Article
Journal
Cardiovascular diagnosis and therapy
Publication Date
Apr 01, 2020
Volume
10
Issue
2
Pages
183–192
Identifiers
DOI: 10.21037/cdt.2020.01.11
PMID: 32420098
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Heart failure with reduced ejection fraction (HFrEF) caused by coronary heart disease (CHD) accounts for the largest proportion of patients with heart failure and is associated with the poorest prognosis. However, date on the perioperative risk and long-term survival of patients with HFrEF are limited. The present study aimed at exploring the effects of the left ventricular end-systolic volume index (LVESVI) and myocardial viability on perioperative risk and long-term survival after coronary artery bypass grafting (CABG) in patients with HFrEF. This is a single center, prospective, observational study. CHD patients with symptoms and signs of heart failure and a left ventricular ejection fraction (LVEF) <40% were enrolled consecutively from January 2014 to February 2018. Operative mortality, perioperative complications and long-term survival were compared in the patients with various LVESVIs and myocardial viabilities. The primary outcomes were cardiac death, myocardial infarction, heart failure, stroke and revascularization [percutaneous coronary intervention (PCI) or redo CABG] with a median follow-up of 30±12 months. Perioperative mortality was 6.8% in the 118 patients in this study. Perioperative mortality was significantly higher in the low myocardial viability (LMV) group than in the high myocardial viability (HMV) group (12.5% vs. 3.8%, P=0.034). The 12-, 24-, 36-month major adverse cardiac event (MACE)-free survival rate of patients with HMV was significantly higher than that of patients with LMV (HMV vs. LMV: 96.9% vs. 88.6%, 93.4% vs. 85.5%, 79.4% vs. 68.2%, P=0.004). There was no difference in MACE-free survival among patients with different degrees of left ventricular remodeling within each group. Myocardial viability is an important factor that affects the perioperative mortality and long-term survival of patients with ischemic HFrEF after CABG. Left ventricular remodeling increases perioperative mortality but has no effect on long-term survival. 2020 Cardiovascular Diagnosis and Therapy. All rights reserved.

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