Anterior wall viability and low ejection fraction predict functional improvement after CABG

Area of Science:

• Cardiology
• Cardiac Imaging
• Cardiovascular Surgery

Background:

• Absence of myocardial hyperenhancement on cardiac magnetic resonance imaging (CMR) predicts functional improvement after coronary artery bypass graft surgery (CABG).
• However, not all patients with absence of hyperenhancement improve their left ventricular ejection fraction (LVEF) after CABG.
• Other characteristics associated with improvement in LVEF after CABG were investigated.

Purpose of the Study:

• To identify predictors of left ventricular ejection fraction (LVEF) improvement after coronary artery bypass graft surgery (CABG).
• To determine factors associated with functional recovery in patients undergoing CABG.

Main Methods:

• Preoperative cardiac magnetic resonance imaging (CMR) was performed on 95 patients undergoing CABG.
• Follow-up LVEF was assessed by echocardiogram postoperatively.
• CMR and clinical factors were analyzed for predictors of functional improvement, defined as a postoperative increase in LVEF ≥10%.

Main Results:

• Patients who improved LVEF had lower preoperative LVEF and higher anterior wall viability.
• Preoperative LVEF and left ventricular end systolic volume index were significant predictors of LVEF improvement by multivariable logistic regression.
• Mean LVEF improved significantly from 28% preoperatively to 38% postoperatively (P<0.0001).

Conclusions:

• Recruitment of viable, non-functioning anterior wall myocardium contributes to LVEF improvement post-CABG.
• Low preoperative LVEF, a non-remodeled left ventricle, and anterior wall viability predict LVEF improvement after CABG.
• These criteria can aid clinicians in selecting patients who may benefit from surgical revascularization.