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Value of echocardiography for stroke and mortality prediction following coronary artery bypass grafting

Orit Kluck1, Marius Berman, Alon Stamler

  • 1Department of Cardiology, Echocardiographic Unit, Rabin Medical Center, Beilinson Campus, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Interactive Cardiovascular and Thoracic Surgery
|August 3, 2007
PubMed

Insights

Transthoracic echocardiography before coronary artery bypass grafting (CABG) can predict stroke. Left ventricular hypertrophy is a significant predictor of post-CABG stroke, while other echocardiographic findings showed limited predictive value.

Area of Science:

  • Cardiology
  • Neurology
  • Medical Imaging

Background:

  • Coronary artery bypass grafting (CABG) carries risks of stroke and death.
  • Clinical and laboratory factors are known predictors of these adverse events.
  • The predictive value of pre-operative transthoracic echocardiography (TTE) requires further investigation.

Purpose of the Study:

  • To determine if pre-operative TTE findings predict perioperative cerebrovascular accident (CVA) and death after CABG.
  • To identify specific echocardiographic markers associated with increased risk.
  • To compare the predictive value of TTE with established risk factors.

Main Methods:

  • Retrospective review of 572 patients undergoing CABG with pre-operative TTE.
  • Analysis of echocardiographic variables including left ventricular (LV) size, function, hypertrophy, mitral annulus calcification (MAC), and aortic valve calcification (AVC).
  • Multivariate analysis to identify independent predictors of post-CABG stroke and death.

Main Results:

  • 33 patients (5.8%) experienced a neurological event, and 26 (4.5%) died.
  • Multivariate analysis identified previous stroke, renal failure, and older age as stroke risk factors.
  • Intra-aortic balloon pump insertion and peripheral vascular disease were significant risk factors for death; medically treated dyslipidemia was protective.
  • Left ventricular hypertrophy significantly predicted stroke on univariate analysis (P=0.02).
  • No significant correlation found between AVC/MAC and stroke, though MAC showed a trend towards increased mortality.

Conclusions:

  • Pre-operative TTE, particularly LV hypertrophy, offers additional predictive value for post-CABG stroke.
  • Established clinical risk factors remain primary predictors for stroke and death.
  • Further research may refine the role of specific echocardiographic findings in risk stratification for CABG patients.

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