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Published on: March 27, 2018
Preoperative echocardiographic parameters influencing quality of life five years after coronary artery bypass graft
Marija Zdravković1, Miljko Ristić, Natasa Milić
1Clinical Center "Bezanijska Kosa", Clinic for Cardiology, Belgrade, Serbia. majadare@EUnet.yu
Insights
Echocardiographic measurements like left ventricle diameter and ejection fraction can predict quality of life after coronary artery bypass graft surgery. These simple preoperative tests offer valuable insights beyond survival prediction.
Area of Science:
- Cardiovascular Surgery
- Cardiac Echocardiography
- Quality of Life Assessment
Background:
- Mortality and morbidity factors after coronary artery bypass graft (CABG) surgery are established, with the Parsonnet score widely used for mortality prediction.
- Preoperative echocardiographic factors influencing postoperative quality of life (QoL) following CABG surgery are poorly documented.
- Integrating QoL evaluation into routine clinical practice remains a challenge.
Purpose of the Study:
- To evaluate echocardiographic parameters that influence quality of life (QoL) five years after coronary artery bypass graft (CABG) surgery.
- To assess the correlation between these echocardiographic parameters and the established Parsonnet score for mortality prediction.
Main Methods:
- A retrospective-prospective study included 449 patients undergoing myocardial revascularization between 1999 and 2000.
- 180 patients with complete revascularization and without comorbidities were followed for 60 months for QoL evaluation using the SF-36 questionnaire.
- Echocardiographic parameters including End-Diastolic Diameter (EDD), End-Systolic Diameter (ESD), and ejection fraction (EF) were analyzed.
Main Results:
- Left atrium and left ventricle dilatation, low left ventricle ejection fraction (EF), impaired contractility, and severe mitral regurgitation were negatively correlated with QoL.
- Receiver Operating Characteristic (ROC) analysis identified specific cut-off values for EDD (54.5 mm), ESD (37.5 mm), and EF (50%) for predicting optimal QoL.
- These echocardiographic parameters demonstrated predictive value for QoL, with varying sensitivity and specificity.
Conclusions:
- Preoperative echocardiographic parameters are valuable predictors of postoperative survival following CABG surgery.
- These easily obtainable echocardiographic measurements also significantly predict the quality of life experienced by patients five years after CABG.
- Echocardiography offers a dual predictive capability for both survival and long-term QoL in CABG patients.
Background/Aim:
Factors associated with mortality and morbidity following coronary artery bypass graft surgery have been well defined and the Parsonnet score is widely used in mortality prediction. The evaluation of quality of life has not been still implemented in everyday work and preoperative echocardiographic factors affecting the quality of life in patients undergoing coronary artery bypass graft surgery have been poorly documented. The aim of this study was to evaluate echocardiographic parameters influencing quality of life following coronary artery bypass graft surgery and its correlation with widely used Parsonnet score.
Methods:
A total of 449 consecutive patients with myocardial revascularization, operated during 1999 and 2000 were enrolled in this retrospective-prospective study. The patients with comorbidities were excluded as well as those with in complete myocardial revascularization. A group of 180 patients who accepted to participate in quality of life evaluation was followed for 60 months. The quality of life was evaluated using a questionnaire SF-36.
Results:
The mean patients' age was 57.8 +/- 7.8 years, 79.4% were males. A 5-year survival was 84.2%. The mean number of risk factors was 3.4 +/- 1.0. Most of the patients were in New York Heart Association (NYHA) II class (104 of them or 59.4%), 61 of them (34.9%) in NYHA III class and only 10 patients or 5.7% of them were in NYHA IV class. The mean End-Diastolic Diameter (EDD) was 55.3 +/- 5.6 mm, mean End-Systolic Diameter (ESD) 38.7 +/- 5.6 mm and mean ejection fraction (EF) 51.7 +/- 9.6%. Left atrium dilatation (p < 0.001), as well as left ventricle dilatation (p < 0.001), low left ventricle ejection fraction (p < 0.001), multisegmental disorders of contractility (p < 0.001), and severe mitral regurgitation (p < 0.001) were in negative correlation with almost all dimensions of quality of life. ROC analysis showed that left ventricle EDD of 54.5 mm can be used as good cut-off value for prediction of optimal quality of life, with sensitivity of 57% and specificity of 70% (RR = 1.386), left ventricle ESD of 37.5 mm with sensitivity of 65% and specificity of 57% (RR = 0.855) and left ventricle EF of 50% with sensitivity of 61% and specificity of 70% (RR = 0.916).
Conclusion:
Echocardiographic parameters, that can easily be obtained preoperatively, have strong predictive value not only in postoperative survival, but also in determination of the quality of life of the patients five years after coronary artery bypass graft surgery.
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