Related Experiment Video
Updated: Aug 6, 2025
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Prediction of Male Coronary Artery Bypass Grafting Outcomes Using Body Surface Area Weighted Left Ventricular
Zhihui Zhu1,2, Yuehuan Li1, Fan Zhang1
1Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Insights
Body surface area-weighted left ventricular end-diastolic diameter (bLVEDD) better predicts mortality in male patients undergoing coronary artery bypass grafting (CABG). This metric improves upon traditional left ventricular end-diastolic diameter (LVEDD) by accounting for body size.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Imaging
Background:
- Elevated left ventricular end-diastolic diameter (LVEDD) is associated with poorer outcomes in coronary artery bypass grafting (CABG).
- Left ventricular size and volume measurements relative to body surface area (BSA) may enhance outcome prediction accuracy.
Purpose of the Study:
- To evaluate if BSA-weighted LVEDD (bLVEDD) is a more accurate predictor of outcomes in CABG patients than LVEDD alone.
- To assess the predictive value of bLVEDD for mortality and severe adverse events post-CABG.
Main Methods:
- Retrospective cohort study of 9474 elective CABG patients (October 2016 - May 2021).
- Data collected from the Chinese Cardiac Surgery Registry.
- bLVEDD calculated as LVEDD divided by BSA. Primary outcome: 30-day in-hospital mortality; Secondary outcomes: severe postoperative adverse events.
Main Results:
- High LVEDD negatively impacted male mortality and secondary outcomes.
- bLVEDD strongly predicted postsurgery mortality and secondary outcomes in male patients (AUC 0.71 for mortality).
- LVEDD and BSA alone were less significant predictors of mortality in males compared to bLVEDD.
Conclusions:
- bLVEDD is a significant predictor of mortality in male CABG patients.
- bLVEDD accounts for BSA variations, offering a more accurate risk assessment than LVEDD alone.
- The predictive utility of bLVEDD for mortality was not statistically significant in female patients.
Background:
The presence of a high left ventricular end-diastolic diameter (LVEDD) has been linked to a less favorable outcome in patients undergoing coronary artery bypass grafting (CABG) procedures. However, by taking into consideration the reference of left ventricular size and volume measurements relative to the patient's body surface area (BSA), it has been suggested that the accuracy of the predicting outcomes may be improved.
Objective:
We propose that BSA weighted LVEDD (bLVEDD) is a more accurate predictor of outcomes in patients undergoing CABG compared to simply using LVEDD alone.
Methods:
This study was a comprehensive retrospective cohort study that was conducted across multiple medical centers. The inclusion criteria for this study were patients who were admitted for treatment between October 2016 and May 2021. Only elective surgery patients were included in the study, while those undergoing emergency surgery were not considered. All participants in the study received standard care, and their clinical data were collected through the institutional registry in accordance with the guidelines set forth by the Society of Thoracic Surgeons National Adult Cardiac Database. bLVEDD was defined as LVEDD divided by BSA. The primary outcome was in-hospital all-cause mortality (30 days), and the secondary outcomes were postoperative severe adverse events, including use of extracorporeal membrane oxygenation, multiorgan failure, use of intra-aortic balloon pump, postoperative stroke, and postoperative myocardial infarction.
Results:
In total, 9474 patients from 5 centers under the Chinese Cardiac Surgery Registry were eligible for analysis. We found that a high LVEDD was a negative factor for male patients' mortality (odds ratio 1.44, P<.001) and secondary outcomes. For female patients, LVEDD was associated with secondary outcomes but did not reach statistical differences for morality. bLVEDD showed a strong association with postsurgery mortality (odds ratio 2.70, P<.001), and secondary outcomes changed in parallel with bLVEDD in male patients. However, bLVEDD did not reach statistical differences when fitting either mortality or severer outcomes in female patients. In male patients, the categorical bLVEDD showed high power to predict mortality (area under the curve [AUC] 0.71, P<.001) while BSA (AUC 0.62) and LVEDD (AUC 0.64) both contributed to the risk of mortality but were not as significant as bLVEDD (P<.001).
Conclusions:
bLVEDD is an important predictor for male mortality in CABG, removing the bias of BSA and showing a strong capability to accurately predict mortality outcomes.
Trial Registration:
ClinicalTrials.gov NCT02400125; https://clinicaltrials.gov/ct2/show/NCT02400125.
