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Published on: March 27, 2018
Clinical utility of early postoperative cardiac multidetector computed tomography after coronary artery bypass
Doo Kyoung Kang1, Sang Hyun Lim2, Jin Sun Park3
1Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea. kdklsm@ajou.ac.kr.
Insights
Early postoperative cardiac computed tomography (CT) in coronary artery bypass grafting (CABG) patients provides comparable left ventricular (LV) function assessment to echocardiography. Cardiac CT effectively predicts major adverse cardiac events and all-cause death post-CABG.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Coronary artery bypass grafting (CABG) is a common cardiac surgery.
- Accurate assessment of left ventricular (LV) function and prognosis post-CABG is crucial for patient management.
- Early postoperative evaluation of cardiac function aids in timely intervention and outcome prediction.
Purpose of the Study:
- To evaluate the clinical utility of early postoperative cardiac computed tomography (CT) in assessing LV function after CABG.
- To determine the predictive value of cardiac CT parameters for prognosis, including major adverse cardiac events (MACE) and all-cause death.
- To compare the diagnostic performance of cardiac CT with echocardiography for LV function assessment.
Main Methods:
- A cohort of 136 patients who underwent CABG and early postoperative cardiac CT (within 30 days) was studied.
- Left ventricular ejection fraction (LVEF) and wall motion score index (WMSI) were measured using both cardiac CT and echocardiography.
- Patients were followed for a mean of 5.9 years to record MACE and mortality.
- Logistic regression analyses were used to assess the association between imaging findings and clinical outcomes.
Main Results:
- Cardiac CT-derived LVEF was significantly higher than echocardiography-derived LVEF (61.9% vs. 56.2%, p=0.0002).
- WMSI measurements were comparable between cardiac CT and echocardiography (p=0.5041).
- Both LVEF and WMSI from cardiac CT and echocardiography predicted MACE.
- Cardiac CT-derived WMSI was the only significant predictor of all-cause death (OR=10.6017, p=0.0035).
Conclusions:
- Early postoperative cardiac CT provides LV function assessment comparable to echocardiography in CABG patients.
- Cardiac CT parameters, particularly WMSI, are valuable for predicting MACE and all-cause death after CABG.
- Cardiac CT is a clinically useful tool for the early postoperative evaluation and prognostic assessment of patients following CABG.
Abstract:
We evaluated the clinical utility of early postoperative cardiac computed tomography (CT) for evaluating left ventricular (LV) function and predicting prognosis in patients who had undergone coronary artery bypass grafting (CABG). Of the 205 patients who underwent CABG from March 2011 to December 2014, 136 underwent early postoperative cardiac CT (within 30 days after CABG) and were enrolled as the study population. The baseline and postoperative follow-up echocardiographic findings, major adverse cardiac events (MACE), and death were recorded for a follow-up period (mean, 5.9 ± 1.1 years). Functional cardiac CT parameters were compared to echocardiographic measurements. The associations between cardiac CT findings and functional recovery and prognosis were evaluated by logistic regression analyses. The LVEF measured via cardiac CT was significantly higher (56.2 ± 11.5% vs. 61.9 ± 12.9%; p = 0.0002) compared to those via early postoperative echocardiography, but the wall motion score index (WMSI) was not significantly different (1.23 ± 0.33 vs. 1.21 ± 0.28, p = 0.5041) between the two methods. During the follow-up period, 17 patients (12.5%) died and 40 (29.4%) developed MACE. Both the LVEF and WMSI measured with early postoperative echocardiography (p = 0.0202 and odds ratio [OR] = 5.0171, p = 0.0039, respectively), and cardiac CT (OR = 0.9625, p = 0.0091 and OR = 14.3605, p = 0.0001, respectively) predicted MACE OR = 0.9630, but only the WMSI, measured using cardiac CT, predicted all-cause death (OR = 10.6017, p = 0.0035). In CABG patients, LVEF and the WMSI measured with early postoperative cardiac CT were comparable with echocardiography and predicted the development of MACE and all-cause death.
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