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Published on: March 27, 2018
Predictors of long-term outcome in patients with left ventricular dysfunction following coronary artery bypass
Anna Rybicka-Musialik1, Krzysztof Szydło, Krystian Wita
11st Department of Cardiology, Medical University of Silesia, Katowice, Poland. rybickaanna@op.pl
Insights
In patients after coronary artery bypass grafting (CABG) with left ventricular (LV) dysfunction, angina and low ejection fraction (LVEF) predict mortality. Combining LVEF <30% with specific ECG findings can identify high-risk individuals.
Area of Science:
- Cardiology
- Cardiac Surgery
- Clinical Prognostics
Background:
- Prognostic significance of clinical and non-invasive risk markers post-revascularization is unclear, especially in post-infarction patients with left ventricular (LV) dysfunction.
- Left ventricular dysfunction (LVEF) is a critical factor influencing outcomes after cardiac procedures.
Purpose of the Study:
- To assess survival and the predictive power of clinical and non-invasive risk markers for all-cause mortality (ACM) and cardiovascular mortality (CVM).
- To evaluate prognostic value in post-coronary artery bypass grafting (CABG) patients with LV dysfunction.
Main Methods:
- Prospective follow-up of 61 post-CABG patients (LVEF 33+/-6%) for a median of 46 months.
- Analysis of demographics, clinical data, LVEF, QRS duration, late potentials (LP), QT dispersion, premature ventricular contractions (PVCs), non-sustained ventricular tachycardia (nsVT), and SDNN.
- Evaluation of ACM and CVM using univariate and multivariable Cox analyses.
Main Results:
- Incomplete revascularization, angina, heart failure, low LVEF, and specific medications predicted poor outcomes in univariate analysis.
- Presence of LP or prolonged QRS complex were also significant predictors.
- Combination of angina and low LVEF emerged as the best multivariable model for predicting both ACM and CVM.
Conclusions:
- Angina class and low LVEF are primary predictors of ACM and CVM in post-CABG patients with LV dysfunction.
- Combining LVEF <30% with QRS >120 ms or LP aids in identifying high-risk subjects.
- Common non-invasive markers (arrhythmic, autonomic) may have reduced predictive power in post-CABG patients on beta-blockers.
Background:
Prognostic significance of clinical and non-invasive risk markers in patients after surgical revascularisation remains unclear, especially in post-infarction patients with left ventricular (LV) dysfunction.
Aim:
The single-centre, prospective study was designed to assess survival and the predictive power of several clinical and non- -invasive risk markers of all-cause (ACM) and cardiovascular mortality (CVM) in post-CABG patients with LV dysfunction.
Methods:
A cohort of 61 patients (age 59+/-9 years, 49 males, LVEF 33+/-6%) 6-12 months after CABG was prospectively followed for a median of 46 months. Demographics, clinical data, medication, LVEF, QRS>120 ms or late potentials (LP) presence, QT dispersion ł80 ms, premature ventricular contractions (PVC) ł10/h, non-sustained ventricular tachycardia (nsVT), and SDNN Ł70 ms in ambulatory ECG were analysed. The ACM and CVM were evaluated. The prognostic value of analysing parameters was determined.
Results:
Fourteen patients died, 10 of them due to cardiovascular causes. Univariate Cox analysis showed that incomplete revascularisation, history of angina, heart failure, low LVEF, use of nitrates, digitalis or diuretics, and presence of LP or prolongation of QRS complex were predictors of poor outcome. Combination of angina and low LVEF was the best model in a multivariable Cox analysies for the prediction of both types of death.
Conclusions:
The present study showed that in post-CABG patients with LV dysfunction, angina class and low LVEF are the main predictors of ACM and CVM. Combination of LVEF <30% with the presence of QRS >120 ms or LP may also be helpful in the identification of high-risk subjects. Other common non-invasive risk markers, particularly arrhythmic and autonomic, seem to lose some of their predictive power in patients after CABG and receiving beta-blocking agents.
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