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Prior DL, Stevens SR, Holly TA, Krejca M, Paraforos A, Pohost GM, Byrd K, Kukulski T, Jones RH, Desvigne-Nickens P, Varadarajan P, Amanullah A, Lin G, Al-Khalidi HR, Aldea G, Santambrogio C, Bochenek A, Berman DS. Regional left ventricular function does not predict survival in ischaemic cardiomyopathy after cardiac surgery. Heart 2017; 103:1359-1367. [PMID: 28446548 DOI: 10.1136/heartjnl-2016-310693] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 02/08/2017] [Accepted: 02/12/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To define the prognostic contribution of global and regional left ventricular (LV) function measurements in patients with ischaemic cardiomyopathy randomised to coronary artery bypass graft surgery (CABG) with (n=501) or without (n=499) surgical ventricular reconstruction (SVR). METHODS Novel multivariable methods to analyse global and regional LV systolic function were used to better formulate prediction models for long-term mortality following CABG with or without SVR in the entire cohort of 1000 randomised SVR hypothesis patients. Key clinical variables were included in the analysis. Regional function was classified according to the discreteness of anteroapical hypokinesia and akinesia into those most likely to benefit from SVR, those least likely and those felt to have intermediate likelihood of benefit from SVR. RESULTS The most prognostic clinical variables identified in multivariable models include creatinine, LV end-systolic volume index (ESVI), age and NYHA (New York Heart Association) class. Addition of LV ejection fraction, LV end-diastolic volume index and regional function assessment did not contribute additional power to the model. Subgroup analysis based on regional function did not identify a cohort in which SVR improved mortality. CONCLUSIONS ESVI is the single parameter of LV function most predictive of mortality in patients with LV systolic dysfunction following CABG with or without SVR in multivariable models that include all key clinical and LV systolic function parameters. Assessment of regional cardiac function does not enhance prediction of mortality nor identify a subgroup for which SVR improves mortality. These results do not support elective addition of LV reconstruction surgery in patients undergoing CABG. TRIAL REGISTRATION NUMBER NCT00023595.
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Affiliation(s)
- David L Prior
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia
| | - Susanna R Stevens
- Duke Clinical Research Institute (SRS,RHJ,HRA) and Department of Surgery Cardiothoracic (RHJ), Duke University School of Medicine, Durham, North Carolina, USA
| | - Thomas A Holly
- Department of Medicine-Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michal Krejca
- 1st Cardiac Surgery Department, Medical University of Silesia, Katowice, Poland
| | | | - Gerald M Pohost
- Department of Medicine-Cardiology, University of Southern California, Los Angeles, California, USA
| | - Krysti Byrd
- Duke Clinical Research Institute (SRS,RHJ,HRA) and Department of Surgery Cardiothoracic (RHJ), Duke University School of Medicine, Durham, North Carolina, USA
| | - Tomasz Kukulski
- Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia, Katowice, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Robert H Jones
- Duke Clinical Research Institute (SRS,RHJ,HRA) and Department of Surgery Cardiothoracic (RHJ), Duke University School of Medicine, Durham, North Carolina, USA
| | - Patrice Desvigne-Nickens
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Padmini Varadarajan
- Department of Medicine-Cardiology, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Aman Amanullah
- Department of Medicine-Cardiology, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA
| | - Grace Lin
- Department of Medicine-Cardiology, Mayo Clinic, Rochester, New York, USA
| | - Hussein R Al-Khalidi
- Duke Clinical Research Institute (SRS,RHJ,HRA) and Department of Surgery Cardiothoracic (RHJ), Duke University School of Medicine, Durham, North Carolina, USA
| | - Gabriel Aldea
- Department of Surgery-Cardiothoracic, University of Washington Medical Center, Seattle, Washington, USA
| | | | - Andrzej Bochenek
- 1st Cardiac Surgery Department, Medical University of Silesia, Katowice, Poland
| | - Daniel S Berman
- Department of Medicine-Nuclear Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
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