Perioperative changes in left ventricular systolic function following surgical revascularization

Area of Science:

• Cardiology
• Cardiac Surgery
• Heart Failure Research

Background:

• Left ventricular systolic dysfunction affects nearly one-third of patients undergoing coronary artery bypass graft surgery (CABG).
• The impact of CABG on left ventricular ejection fraction (LVEF) in these patients remains incompletely understood.
• Limited data exists on the extent, direction, and clinical implications of perioperative LVEF changes.

Purpose of the Study:

• To investigate perioperative changes in left ventricular ejection fraction (LVEF) among patients with systolic dysfunction undergoing CABG.
• To identify factors influencing LVEF changes after CABG.
• To determine the association between LVEF improvement and long-term mortality.

Main Methods:

• Analysis of 549 patients with left ventricular systolic dysfunction (LVEF <50%) from the STICH trial undergoing CABG.
• Pre- and post-CABG (4-month) LVEF assessments using identical cardiac imaging, interpreted at a core laboratory.
• Clinically significant LVEF change defined as an absolute change >10%.

Main Results:

• 26.4% of patients experienced a >10% improvement in LVEF post-CABG; 67.2% had no significant change; 6.4% had >10% worsening.
• Lower preoperative LVEF was associated with a higher likelihood of LVEF improvement (OR 1.36).
• Postoperative LVEF improvement was not influenced by myocardial viability and was linked to a 57% lower risk of all-cause mortality (HR 0.43).

Conclusions:

• A significant proportion of patients with ischemic cardiomyopathy undergoing CABG show improved LVEF.
• LVEF improvement is more common in patients with lower baseline LVEF.
• Post-CABG LVEF improvement is a significant predictor of enhanced long-term survival.