Smaller left ventricular end-systolic diameter and lower ejection fraction at baseline associated with greater
Shaoping Wang1, Yi Lyu2, Shujuan Cheng1
1Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China.
Insights
For coronary artery disease patients with reduced ejection fraction (EF), smaller left ventricular size and lower EF before revascularization predict greater EF improvement and better outcomes. This suggests revascularization is beneficial for patients with LV dysfunction, lower EF, and smaller LV size.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- Revascularization can improve left ventricular (LV) function and outcomes in patients with coronary artery disease (CAD) and LV dysfunction.
- Predictors of EF improvement after revascularization in this population remain incompletely understood.
Purpose of the Study:
- To determine the predictive value of pre-operative LV size and ejection fraction (EF) for EF improvement and clinical outcomes after revascularization in CAD patients with LV dysfunction.
Main Methods:
- A cohort study included 939 patients with baseline EF ≤ 40% and EF measurements pre- and post-revascularization.
- Patients were categorized into four groups based on baseline LV end-systolic diameter (LVESD) and EF.
- EF improvement was defined as an absolute increase > 5%.
Main Results:
- A total of 58.5% of patients showed EF improvement.
- Both smaller LV end-systolic diameter (LVESD) and lower baseline EF were significant predictors of EF improvement.
- Patients with non-severely enlarged LVESD and EF ≤ 35% had higher odds of EF improvement and a significantly lower risk of all-cause mortality during a median 3.5-year follow-up.
Conclusions:
- In CAD patients with reduced EF (≤ 40%) undergoing revascularization, smaller pre-operative LVESD and lower EF are associated with the greatest potential for EF improvement and better long-term outcomes.
- These findings support considering revascularization for patients with LV dysfunction, particularly those presenting with lower EF and smaller LV size.
Objectives:
To investigate the predictive roles of pre-operative left ventricular (LV) size and ejection fraction (EF) in EF improvement and outcome following revascularization in patients with coronary artery disease (CAD) and LV dysfunction.
Background:
Revascularization may improve EF and long-term outcomes of patients with LV dysfunction. However, the determinants of EF improvement have not yet been investigated comprehensively.
Materials And Methods:
Patients with EF measurements before and 3 months after revascularization were enrolled in a cohort study (No. ChiCTR2100044378). All patients had baseline EF ≤ 40%. EF improvement was defined as absolute increase in EF > 5%. According to LV end-systolic diameter (LVESD) (severely enlarged or not) and EF (≤35% or of 36-40%) at baseline, patients were categorized into four groups.
Results:
A total of 939 patients were identified. A total of 549 (58.5%) had EF improved. Both LVESD [odds ratio (OR) per 1 mm decrease, 1.05; 95% CI, 1.04-1.07; P < 0.001] and EF (OR per 1% decrease, 1.06; 95% CI, 1.03-1.10; P < 0.001) at baseline were predictive of EF improvement after revascularization. Patients with LVESD not severely enlarged and EF ≤ 35% had higher odds of being in the EF improved group in comparison with other three groups both in unadjusted and adjusted analysis (all P < 0.001). The median follow-up time was 3.5 years. Patients with LVESD not severely enlarged and EF ≤ 35% had significantly lower risk of all-cause death in comparison with patients with LVESD severely enlarged and EF ≤ 35% [hazard ratio (HR), 2.73; 95% CI, 1.28-5.82; P = 0.009], and tended to have lower risk in comparison with patients with LVESD severely enlarged and EF of 36-40% (HR, 2.00; 95% CI, 0.93-4.27; P = 0.074).
Conclusion:
Among CAD patients with reduced EF (≤ 40%) who underwent revascularization, smaller pre-operative LVESD and lower EF had greatest potential to have EF improvement and better outcome. Our findings imply the indication for revascularization in patients with LV dysfunction who presented with lower EF but smaller LV size.
