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Published on: March 27, 2018
The Effect of Coronary Artery Bypass Graft Surgery on Contractile Function and Symptoms in Patients with Left
Fernando Bassan1, Roberto Esporcatte2, Marcelo Goulart Correia
1Instituto Nacional de Cardiologia, Rio de Janeiro, RJ - Brasil.
Insights
Coronary artery bypass graft (CABG) surgery improved left ventricular (LV) function and reduced symptoms in patients with chronic coronary syndrome (CCS) and reduced ejection fraction. Cerebrovascular disease predicted LV function improvement after CABG.
Area of Science:
- Cardiology
- Cardiac Surgery
- Heart Failure Research
Background:
- Left ventricular (LV) dysfunction in chronic coronary syndrome (CCS) independently predicts poor patient outcomes.
- Coronary artery bypass graft (CABG) surgery is standard for ischemic heart failure but improvement predictors remain unclear.
Purpose of the Study:
- To evaluate the impact of myocardial revascularization via CABG on LV function and symptoms in CCS patients with reduced ejection fraction.
- To identify predictors of functional improvement following CABG in this patient cohort.
Main Methods:
- Retrospective analysis of 136 CCS patients with LV ejection fraction (LVEF) <50% who underwent CABG.
- Echocardiographic assessment of LV function and wall motion score index (WMSI) at baseline, short-term (3.6 months), and long-term (30.8 months).
Main Results:
- Significant long-term improvement in mean LVEF (40.9% to 48.1%) and WMSI (1.99 to 1.75) post-CABG (p<0.001).
- Over 55% of patients showed significant LVEF and WMSI improvement (≥10%).
- Cerebrovascular disease was the sole predictor of LVEF improvement; functional class significantly improved (65.4% to 10.3% in NYHA class III/IV, p<0.001).
Conclusions:
- CABG surgery leads to enhanced LV contractile function and size in CCS patients with reduced LVEF.
- Patients undergoing CABG experience significant symptomatic improvement, as evidenced by reduced functional class.
Background:
The degree of left ventricular (LV) dysfunction is an independent risk factor for poor outcomes in patients with chronic coronary syndrome. Coronary artery bypass graft (CABG) is the standard care for the management of ischemic heart failure to improve symptoms and prognosis. However, the predictors of improvement are still uncertain.
Objective:
To assess the effect of myocardial revascularization on LV function and symptoms in patients with CCS and reduced left ventricular ejection fraction (LVEF), as well as to identify the improvement predictors.
Methods:
We retrospectively analyzed the data and clinical status of 136 consecutive patients with LVEF<50% that underwent CABG. During clinical follow-up echocardiographic LV function was reassessed at the short-term (3.6 months) and long-term (30.8 months), and compared to baseline.
Results:
Mean pre-operative LVEF was 40.9 ± 8.6% and wall motion score index (WMSI) was 1.99 ± 0.36, both improving at long-term to 48.1 ± 15.0% (p<0.001) and 1.75 ± 0.49 (p<0.001), respectively. We observed that 55.7% of the patients presented an improvement of LVEF≥10% and 58.1% in WMSI ≥10%. Univariate logistic regression analysis revealed that cerebrovascular disease was the only variable to be predictor of LVEF improvement. At the end of follow-up, we observed a reduction in the rate of patients in functional class III/IV when compared to baseline (65.4 vs. 10.3% - p<0.001).
Conclusions:
Patients with CCS and reduced LVEF undergoing CABG experienced improvement in both LV contractile function and size, with beneficial response in functional class.
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