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Comprehensive assessment of heart failure in patients with preserved ejection fraction undergoing coronary bypass

Seung Hun Lee1, Ki Hong Choi2, Young Bin Song2

  • 1Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Republic of Korea.

The Journal of Thoracic and Cardiovascular Surgery
|July 4, 2021
PubMed

Insights

Patients with heart failure with preserved ejection fraction undergoing coronary artery bypass grafting have lower 5-year survival. Preoperative diastolic dysfunction negatively impacts long-term outcomes after this cardiac surgery.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Heart Failure Research

Background:

  • Coronary artery bypass grafting (CABG) aims to improve outcomes in advanced coronary artery disease (CAD).
  • The prognostic impact of preoperative diastolic function, specifically heart failure with preserved ejection fraction (HFpEF), in CABG patients is not well understood.

Purpose of the Study:

  • To evaluate the prognostic significance of preoperative HFpEF in patients undergoing CABG.
  • To determine if preoperative diastolic dysfunction affects long-term survival after CABG.

Main Methods:

  • Retrospective analysis of 3593 patients with preserved ejection fraction (≥50%) who underwent CABG (2001-2017).
  • Patients stratified into non-HFpEF (low-risk), indeterminate (intermediate-risk), and HFpEF (high-risk) groups using the HFA-PEPF score.
  • Primary outcome: all-cause death at 5 years post-surgery.

Main Results:

  • 27.4% of patients had preoperative HFpEF.
  • No significant difference in 30-day survival between HFpEF and non-HFpEF groups.
  • 5-year survival was significantly lower in the HFpEF group (91.9%) compared to the non-HFpEF group (97.0%; aHR, 2.41; P=.006).
  • No significant changes in diastolic function parameters were observed post-CABG in the HFpEF group.

Conclusions:

  • A significant proportion of CABG patients exhibit preoperative HFpEF based on noninvasive assessment.
  • Preoperative HFpEF is a significant independent predictor of reduced 5-year survival following successful CABG.
  • Diastolic dysfunction impacts long-term prognosis in patients undergoing CABG for CAD.
Abstract

Keywords:
coronary artery bypass graft surgerycoronary artery diseaseheart failureleft ventricular diastolic dysfunctionprognosis

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