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Prognostic implications of left ventricular geometry in coronary artery bypass grafting patients
Pengxiong Zhu1, Yanan Dai2, Jiapei Qiu1
1Department of Cardiac Surgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Insights
Left ventricular geometry significantly impacts outcomes in coronary artery bypass grafting (CABG) patients. Assessing LV geometry improves risk prediction for major adverse cardiovascular and cerebrovascular events (MACCE) and death post-CABG.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Imaging
Background:
- Prognostic implications of left ventricular (LV) mass and geometry are established in various cardiac diseases.
- The prognostic value of LV geometry specifically in coronary artery bypass grafting (CABG) patients remains unclear.
Purpose of the Study:
- To investigate the prognostic significance of LV geometry in patients undergoing CABG.
- To determine if LV geometry improves risk stratification for adverse cardiovascular and cerebrovascular events.
Main Methods:
- A cohort of 2,517 patients undergoing CABG was analyzed.
- Patients were classified into four groups based on LV mass index (LVMi) and relative wall thickness (RWT): normal geometry, concentric remodeling, eccentric hypertrophy, and concentric hypertrophy.
- Follow-up data on major adverse cardiovascular and cerebrovascular events (MACCE) and mortality were collected.
Main Results:
- All forms of abnormal LV geometry (concentric remodeling, eccentric hypertrophy, concentric hypertrophy) were associated with significantly higher MACCE risk compared to normal geometry.
- Increased LVMi and RWT were independently associated with elevated MACCE risk and mortality.
- Incorporating LV geometry into the EuroSCORE II model significantly improved its predictive accuracy for MACCE and death, demonstrating substantial integrated discrimination and net reclassification improvements.
Conclusions:
- Left ventricular geometry is an independent and incremental prognostic factor for MACCE and mortality in CABG patients.
- LV geometry assessment provides valuable additional information for risk stratification beyond existing scores like EuroSCORE II.
Background:
The prognostic implications of left ventricular (LV) mass and geometry have been confirmed in populations with different cardiac diseases. However, the prognostic value of LV geometry in coronary artery bypass grafting (CABG) patients is unclear.
Methods:
A total of 2,517 patients undergoing CABG between January 2012 and September 2016 in our cardiac surgery unit were included. Patients were divided into the following 4 groups according to left ventricular mass index (LVMi) and relative wall thickness (RWT): normal geometry, concentric remodeling, eccentric hypertrophy, and concentric hypertrophy.
Results:
The median follow-up period was 47.0 months (interquartile range was 32.5-61.3 months). Compared to the normal geometry group, the concentric remodeling group [hazard ratio (HR): 3.023; 95% confidence interval (CI): 1.134-8.060], the eccentric hypertrophy group (HR: 3.422; 95% CI: 1.395-8.398), and the concentric hypertrophy group (HR: 5.399; 95% CI: 2.289-12.735) have higher main adverse cardiovascular and cerebrovascular event (MACCE) risk. Moreover, increased MACCE risk was associated with higher LVMi (HR: 1.015 per 1 g/m2 increase in LVMi; 95% CI: 1.005-1.026) and RWT (HR: 1.991 per 0.1-U increase in RWT; 95% CI: 1.343-2.952). We observed similar results concerning mortality. Adding LV geometry to the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II significantly improved the area under the curve (AUC) for MACCE (from 0.621 to 0.703; P=0.042). The addition of LV geometry showed significant integrated discrimination improvement (IDI) and net reclassification improvement (NRI) for MACCE (IDI: 0.043, P<0.001; NRI: 0.200, P<0.001) and death (IDI: 0.018, P=0.020; NRI: 0.308, P=0.002), as was the addition of LVMi and RWT.
Conclusions:
LV geometry is an independent and incremental prognostic factor for MACCE and death in CABG patients.
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