Multidimensional Echocardiographic Parameters Predict Left Ventricular Functional Recovery After Coronary Artery
Man Zhang1, Jun Xia1, Xiaoling Wan1
1Department of Ultrasound, The First Affiliated Hospital of Yangtze University, 434000 Jingzhou, Hubei, China.
Aim:
This study aimed to investigate the predictive value of preoperative and early postoperative echocardiographic parameters for left ventricular function recovery after coronary artery bypass grafting (CABG), and to evaluate the relationship between functional recovery and 1-year clinical prognosis.
Methods:
This retrospective cohort included 214 patients undergoing first-time elective CABG at The First Affiliated Hospital of Yangtze University between January 2022 and October 2024. Transthoracic echocardiography was performed preoperatively, 3-7 days postoperatively, and at 6 months to evaluate left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), left atrial volume index (LAVI), and ratio of early mitral inflow velocity to early diastolic mitral annular velocity (E/e'). Based on 6‑month LVEF change, patients were divided into recovery (ΔLVEF ≥5%) and non‑recovery (ΔLVEF <5%) groups. Multivariate logistic regression was used to identify independent predictors, and the corresponding models were established and validated. Major adverse cardiovascular events (MACE) were recorded at 1‑year follow‑up.
Results:
Of the 214 patients enrolled in the study, functional recovery of the left ventricle was observed in 128 individuals, corresponding to 59.8% of the cohort. Multivariate analysis identified several preoperative and procedural variables as independent predictors of functional recovery, including left atrial volume index (LAVI), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left atrial diameter (LAD), Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) score, and the number of graft vessels. Age, preoperative LVEF, and e' velocity were independently associated with lower odds of functional recovery. Global longitudinal strain (GLS) and diabetes history showed no independent predictive value. The clinical-echocardiographic combined model demonstrated excellent discrimination and showed higher discriminative performance than the basic clinical model and conventional echocardiographic model. Subgroup analysis revealed that GLS showed no independent predictive value across all LVEF subgroups (p > 0.05), whereas LAVI and LAD were significant predictors in patients with LVEF ≥40% (including the 40%-49% subgroup), but showed no predictive relevance in those with LVEF <40%. Early postoperative ΔLVEF predicted 6-month functional recovery with an area under the curve (AUC) of 0.846. After one year of follow‑up, the recovery group exhibited a markedly lower rate of MACE than the non‑recovery group, with left ventricular functional recovery serving as an independent protective factor against MACE.
Conclusions:
Preoperative structural parameters, including LAVI, LVEDD, LVESD, and LAD, are independent imaging biomarkers for predicting left ventricular functional recovery after CABG. GLS and E/e' ratio show no independent predictive value in this study. The integrated model combining clinical factors with multi-dimensional echocardiographic parameters demonstrates excellent discriminative ability. Early postoperative LVEF improvement strongly predicts 6-month functional recovery, while postoperative recovery of left ventricular function is associated with a significantly lower 1-year MACE risk.
