Incremental value of the preoperative echocardiogram to predict mortality and major morbidity in coronary artery...

Area of Science:

• Cardiology
• Cardiac Surgery
• Diagnostic Imaging

Background:

• Echocardiography is standard before coronary artery bypass surgery (CAB surgery).
• The added prognostic value of a complete echocardiogram is not well-established.
• This study investigates the incremental prognostic utility of preoperative echocardiography.

Purpose of the Study:

• To determine if quantitative echocardiographic parameters improve risk stratification for patients undergoing isolated CAB surgery.
• To assess the impact of echocardiography on predicting in-hospital mortality/morbidity and long-term mortality.

Main Methods:

• Patients undergoing isolated CAB surgery were divided into derivation (667) and validation (187) cohorts.
• Quantitative echocardiographic parameters and clinical data from the Society of Thoracic Surgeons database were analyzed.
• Outcomes included in-hospital mortality/major morbidity and long-term all-cause mortality.

Main Results:

• Severe diastolic dysfunction (restrictive filling), right ventricular dysfunction (FAC <35%), and elevated myocardial performance index (>0.40) predicted mortality/morbidity.
• These findings were validated in a separate cohort.
• Adding echocardiographic parameters to the Society of Thoracic Surgeons risk score improved model discrimination (c-statistic increased from 0.68 to 0.73).

Conclusions:

• Preoperative echocardiography offers significant incremental prognostic value.
• Right ventricular dysfunction and restrictive left ventricular filling are key indicators of increased risk.
• Echocardiography aids in identifying high-risk patients for CAB surgery, potentially improving outcomes.