Influence of wall motion score on mortality after coronary bypass surgery in the CABG-patch trial

¹Electrophysiology Laboratory, Cardiovascular Division, Department of Internal Medicine, University of Virginia Health Sciences Center, Charlottesville, VA 22908, USA. f.jung@em.uni-frankfurt.de

|January 12, 2002

Insights

A low wall motion score (WMS) of <=16% predicts increased perioperative mortality risk in patients undergoing bypass surgery. However, long-term survival did not differ significantly between groups, with potential benefit from ICDs in the low WMS group.

Area of Science:

Cardiology
Cardiac Surgery
Medical Imaging

Background:

Assessing left ventricular (LV) function is crucial for predicting outcomes in cardiac surgery patients.
Wall motion score (WMS) from ventriculography is a potential metric for evaluating LV function.
The CABG-Patch Trial provided a cohort for retrospective analysis of cardiac surgical outcomes.

Purpose of the Study:

To determine if a wall motion score (WMS) of <=16% predicts perioperative or long-term mortality after coronary artery bypass grafting (CABG).
To investigate the prognostic value of WMS in patients with reduced left ventricular ejection fraction (LVEF).

Main Methods:

Retrospective analysis of 189 patients from the CABG-Patch Trial with LVEF <=36%.
Calculation of WMS using chordal analysis from preoperative right anterior oblique (RAO) left ventriculograms.
Patients were stratified into two groups: WMS <=16% and WMS >16%.

Main Results:

No significant difference in ejection fraction (EF) between the WMS groups (26.5% vs. 27.8%).
The WMS <=16% group had a higher perioperative mortality rate (9.9% vs. 2.8%), with a relative risk of 3.6 (P<0.04).
No significant difference in 4-year survival between the WMS groups (P=0.11); however, subgroup analysis suggested benefit from ICD implantation in the WMS <=16% group (P=0.046).

Conclusions:

A WMS of <=16% identifies a subgroup of low EF patients at increased risk for perioperative mortality following bypass surgery.
Long-term survival is not significantly different between WMS groups, but WMS may guide decisions regarding ICD implantation.
WMS assessment from ventriculography offers valuable prognostic information for perioperative risk stratification in CABG patients.

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Abstract

Background:

It was hypothesized that a wall motion score (WMS) of

Methods And Results:

One hundred and eighty-nine patients from the trial with a LVEF of 16% (n=108), respectively, calculated from a preoperative RAO ventriculogram. There was no difference in EF between the two groups (26.5+/-5.5 vs. 27.8+/-5.3%, respectively). Eight (9.9%) versus three (2.8%) patients died perioperatively in the low versus the high WMS group, respectively. The relative risk for perioperative death in the low WMS group was 3.6 (P<0.04). Kaplan-Meier estimates of cumulative survival did not reveal any statistical difference between the two groups over 4 years (P=0.11). Subgroup analysis revealed that patients with a WMS of

Conclusions:

These data indicate that poor LV function, as assessed by a WMS of 16% were not significantly different, although subgroup analysis revealed that patients with a WMS

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Influence of wall motion score on mortality after coronary bypass surgery in the CABG-patch trial

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Methods And Results:

Conclusions:

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