Related Experiment Video
Updated: Oct 7, 2025
Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
Left Ventricular Structure is Associated with Postoperative Death After Coronary Artery Bypass Grafting in Patients
Pengyun Yan1, Kui Zhang1, Jian Cao1
1Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China.
Insights
Left ventricular hypertrophy (LVH) and enlargement (LVE) predict mortality in heart failure with reduced ejection fraction (HFrEF) patients undergoing coronary artery bypass grafting (CABG). Assessing LV structure improves risk stratification for better patient outcomes.
Area of Science:
- Cardiology
- Cardiac Surgery
- Echocardiography
Background:
- Abnormal left ventricular (LV) structure is linked to adverse outcomes in various patient groups.
- The predictive value of LV structure in heart failure with reduced ejection fraction (HFrEF) patients after coronary artery bypass grafting (CABG) is not well-established.
Purpose of the Study:
- To investigate the association between LV structure (hypertrophy and enlargement) and postoperative mortality in HFrEF patients who underwent CABG.
- To assess the incremental predictive value of LV structural patterns for mortality risk stratification.
Main Methods:
- Retrospective enrollment of 435 HFrEF patients who underwent CABG.
- Classification of patients into four LV structure types based on LV hypertrophy (LVH) and LV enlargement (LVE) via echocardiography.
- Multivariate analysis to determine independent predictors of postoperative mortality.
Main Results:
- Both LVH and LVE were independently associated with increased postoperative mortality.
- Combined LVH and LVE patterns significantly increased mortality risk, with the highest risk in patients with both conditions.
- Incorporating LV structural types improved the predictive model for mortality (AUC increased from 0.838 to 0.901).
Conclusions:
- LVH and LVE are significant predictors of postoperative mortality in HFrEF patients undergoing CABG.
- Classifying LV structural patterns enhances risk stratification and predictive accuracy for mortality.
- Routine echocardiographic assessment of LVH and LVE is recommended for clinical practice.
Background:
The relationship between abnormal left ventricular (LV) structure and adverse outcomes has been confirmed in diverse patient groups in previous studies. However, it remains uncertain whether LV structure has predictive implications in heart failure with reduced ejection fraction (HFrEF) patients with coronary artery bypass grafting (CABG).
Methods:
This study retrospectively enrolled patients who had HFrEF and underwent CABG between January 2013 and July 2019. According to LV hypertrophy (LVH) and LV enlargement (LVE) assessed by echocardiography, patients were classified into four LV structure types: (-)LVH/(-)LVE, (+)LVH/(-)LVE, (-)LVH/(+)LVE, and (+)LVH/(+)LVE.
Results:
A total of 435 consecutive patients (mean age: 59.4 ± 9.6 years; 14.9% female) were enrolled in the present study. Examined independently, either LVH (p < 0.001) or LVE (p < 0.001) was independently associated with postoperative mortality in multivariate analysis. When LVH and LVE were analyzed in combination, the risk of mortality after CABG was lowest in (-)LVH/(-)LVE and increased with (+)LVH/(-)LVE (odds ratio [OR]: 7.525; 95% confidence interval [CI]: 1.827-30.679, p = 0.004), (-)LVH/(+)LVE (OR: 7.253; 95% CI: 1.950-27.185, p = 0.003), and (+)LVH/(+)LVE (OR: 9.547; 95% CI: 2.726-34.805, p < 0.001), independent of other risk factors. Adding LV structural types to the baseline model gained an incremental effect on the predictive value for postoperative mortality (AUC: baseline model, 0.838 vs baseline model + LV structural types, 0.901, p for comparison = 0.010; category-free net reclassification improvement (NRI): 0.764, p < 0.001; integrated discrimination improvement (IDI): 0.061, p = 0.007).
Conclusion:
LVH and LVE were associated with an increased risk of postoperative mortality after CABG in patients with HFrEF. Categorizing LV structural patterns with LVH and LVE contributes to risk stratification and provides incremental predictive ability. Routine echocardiographic assessment of LVH and LVE is needed in clinical practice.
Related Concept Videos
01:17Pathophysiology of Heart Failure
01:29Heart Failure II: Pathophysiology
01:29Cardiomyopathy V: Interprofessional Care
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:26Imbalances in Cardiac Output
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send...