Appropriate time for ejection fraction reassessment after revascularization in patients with left ventricular
Shaoping Wang1,2, Yi Lyu3, Shujuan Cheng1
1Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China.
Insights
Reassessing ejection fraction (EF) between 3 to 12 months after revascularization is crucial for accurately stratifying sudden cardiac death (SCD) risk in patients with left ventricular dysfunction. Early EF measurements (<3 months) may not reliably predict SCD risk.
Area of Science:
- Cardiology
- Cardiac Surgery
- Preventive Cardiology
Background:
- The optimal timing for ejection fraction (EF) reassessment post-revascularization in patients with left ventricular dysfunction remains unclear.
- Current guidelines suggest 3 months for sudden cardiac death (SCD) risk stratification, but comprehensive data is lacking.
Purpose of the Study:
- To compare the predictive value of early (<3 months) versus late (3-12 months) EF measurements for all-cause mortality and SCD risk.
- To determine the most appropriate timeframe for cardiac function reassessment and SCD risk stratification after revascularization.
Main Methods:
- A retrospective analysis of 1589 patients with pre-revascularization EF ≤40% and at least one post-procedure EF measurement.
- Comparison of the association between early (<3 months) and late (3-12 months) EF measurements (specifically EF ≤35%) and outcomes (all-cause mortality, SCD).
Main Results:
- Lower EF values were observed when reassessed early (<3 months) compared to late (3-12 months).
- Early EF ≤35% predicted all-cause mortality but not SCD, while late EF ≤35% predicted both all-cause mortality and SCD.
- The contribution of SCD to all-cause death was significantly higher when EF was reassessed between 3-12 months.
Conclusions:
- Cardiac function reassessment and SCD risk stratification between 3 to 12 months after revascularization appear most appropriate.
- Early EF measurements (<3 months) may be less reliable for predicting SCD risk compared to later assessments.
Background:
Appropriate time for ejection fraction (EF) reassessment after revascularization in patients with left ventricular dysfunction has not been investigated comprehensively, although 3 months after revascularization is recommended to stratify the risk of sudden cardiac death (SCD).
Hypothesis:
EF reassessed within different timeframe after revascularization may have incosistent contribution for risk stratification of SCD.
Methods:
Patients who had EF ≤ 40% before revascularization and had EF reassessment at least once during follow-up were included. The role of early (<3 months) versus late (3-12 months) EF measurements in prediction of all-cause mortality and SCD were compared.
Results:
A total of 1589 patients were identified. EF reassessed <3 months was lower than EF reassessed within 3-12 months (42.1 ± 9.7% vs. 45.8 ± 10.8%; p < .01). Among 1069 patients who had EF reassessed <3 months, EF ≤ 35% was associated with a higher risk of all-cause mortality (hazard ratio [HR], 1.67; 95% confidence interval [CI], 1.22-2.29; p < .01), but had no association with the risk of SCD (HR, 1.44; 95% CI, 0.84-2.48; p = .18). By contrast, among 595 patients who had EF reassessed within 3-12 months, EF ≤ 35% was associated with higher risks of both all-cause death (HR, 1.81; 95% CI, 1.06-3.10; p = .03) and SCD (HR, 2.71; 95% CI, 1.31-5.61; p < .01). The relative contribution of SCD to all-cause death was higher in patients with EF ≤ 35% than patients with EF > 35% when EF was reassessed within 3-12 months (p = .04). However, when EF was reassessed <3 months, the mode of death was similar in patients with EF ≤ 35% versus >35% (p = .85).
Conclusions:
3 to 12 months after revascularization may be appropriate for cardiac function reassessment and SCD risk stratification.
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