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Varma PK, Radhakrishnan RM, Gopal K, Krishna N, Jose R. Selecting the appropriate patients for coronary artery bypass grafting in ischemic cardiomyopathy-importance of myocardial viability. Indian J Thorac Cardiovasc Surg 2024; 40:341-352. [PMID: 38681722 PMCID: PMC11045715 DOI: 10.1007/s12055-023-01671-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 05/01/2024] Open
Abstract
Patients who undergo coronary artery bypass graft (CABG) surgery in ischemic cardiomyopathy have a survival advantage over medical therapy at 10 years. The survival advantage of CABG over medical therapy is due to its ability to reduce future myocardial infarction, and by conferring electrical stability. The presence of myocardial viability does not provide a differential survival advantage for CABG over medical therapy. Presence of angina and inducible ischemia are also less predictive of outcome. Moreover, CABG is associated with significant early mortality. Hence, careful patient selection is more important for reducing the early mortality and improving the long-term outcome than relying on results of myocardial viability. Younger patients with good exercise tolerance benefit the most, while patients who are frail and patients with renal dysfunction and dysfunctional right ventricle seem to have very high operative mortality. Elderly patients, because of poor life expectancy, do not benefit from CABG, but the age cutoff is not clear. Patients also need to have revascularizable targets, but this decision is often based on experience of the surgical team and heart team discussion. These recommendations are irrespective of the myocardial viability tests. Optimal medical treatment remains the cornerstone for management of ischemic cardiomyopathy.
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Affiliation(s)
- Praveen Kerala Varma
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Rohik Micka Radhakrishnan
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Kirun Gopal
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Neethu Krishna
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Rajesh Jose
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
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2
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Pastena P, Frye JT, Ho C, Goldschmidt ME, Kalogeropoulos AP. Ischemic cardiomyopathy: epidemiology, pathophysiology, outcomes, and therapeutic options. Heart Fail Rev 2024; 29:287-299. [PMID: 38103139 DOI: 10.1007/s10741-023-10377-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 12/17/2023]
Abstract
Ischemic cardiomyopathy (ICM) is the most prevalent cause of heart failure (HF) in developed countries, with significant morbidity and mortality, despite constant improvements in the management of coronary artery disease. Current literature on this topic remains fragmented. Therefore, this review aimed to summarize the most recent data on ICM, focusing on its definition, epidemiology, outcomes, and therapeutic options. The most widely accepted definition is represented by a left ventricular dysfunction in the presence of significant coronary artery disease. The prevalence of ICM is largely influenced by age and sex, with older individuals and males being more affected. Its pathophysiology is characterized by plaque buildup, thrombus formation, hypoperfusion, ischemic cell death, and left ventricular remodeling. Despite improvements in therapy, ICM still represents a public health burden, with a 1-year mortality rate of 16% and a 5-year mortality rate of approximately 40% in the USA and Europe. Therefore, optimization of cardiovascular function, prevention of progressive remodeling, reduction of HF symptoms, and improved survival are the main goals of treatment. Therapeutic options for ICM include lifestyle changes, optimal medical therapy, revascularization, device therapy, mechanical circulatory support, and cardiac transplantation. Personalized management strategies and tailored patient care are needed to improve the outcomes of patients with ICM.
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Affiliation(s)
- Paola Pastena
- Division of Cardiology, Department of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Jesse T Frye
- Division of Cardiology, Department of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Carson Ho
- College of Arts and Sciences, Stony Brook University, Stony Brook, NY, USA
| | - Marc E Goldschmidt
- Division of Cardiology, Department of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Andreas P Kalogeropoulos
- Division of Cardiology, Department of Medicine, Stony Brook University, Stony Brook, NY, USA.
- Stony Brook University Medical Center, Health Sciences Center, 101 Nicolls Road, T-16-080, Stony Brook, NY, USA.
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Akintoye OO, Fasina OP, Adiat TS, Nwosu PU, Olubodun MO, Adu BG. Outcomes of Coronary Artery Bypass Graft Surgery in Africa: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e47541. [PMID: 37881326 PMCID: PMC10597594 DOI: 10.7759/cureus.47541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 10/27/2023] Open
Abstract
Coronary artery bypass graft (CABG) surgery has been in practice for many decades, and it is one of the most commonly performed cardiac surgeries worldwide. While there are several studies reporting data on perioperative outcomes following CABG in developed countries, there is a staggering paucity of data and evidence reporting the outcomes in developing areas such as Africa. Thus, it is important to study the practice and outcome of CABG in Africa to establish its clinical efficacy and safety in this region and identify factors that might be limiting its practice. The overall aim of this study is to identify all relevant clinical data on CABG in Africa and report on the perioperative outcomes and practice of CABG in the African population. Electronic search was performed using three online databases, PubMed, African Journal Online, and Research Gate, from inception to June 2023. The preferred reporting items for systematic reviews and meta-analysis (PRISMA) guideline was utilised for this study. Relevant studies fulfilling predefined eligibility criteria were included in the study. Intraoperative details, such as the number of grafts performed, operative, bypass, and cross-clamp time, were reported. The primary endpoint assessed were early mortality and overall mortality. The secondary endpoints included length of hospital stay, intensive care unit stay, and postoperative complications, such as renal impairment, atrial fibrillation, and surgical site infection. The data were pooled together and meta-analyzed using a random effect model for proportions and mean for meta-analysis with R software (version 4.3.1 (2023-06-16); R Development Core Team, Vienna, Austria). This systematic review identified 42 studies that fulfilled the study eligibility criteria, including 21 randomised controlled trials, 20 observational studies, and one cross-sectional study. Only four out of the 54 countries in Africa had studies carried out that met the criteria for this review; they included Algeria, Egypt, Nigeria, and South Africa, with a majority from Egypt. Meta-analysis reported a pooled early mortality and pooled overall mortality of 3.51% and 3.73%, respectively, for the total cohort of patients. The result of this meta-analysis suggests that mortality outcomes following CABG in Africa are relatively higher than those in developed nations. Several issues, such as lack of financial resources and poor infrastructure, continue to hinder the optimal practice of CABG procedures in many parts of Africa. Further studies focused on finding factors associated with outcomes following CABG should be done. Though there were a few limitations to the study largely from a lack of data from several regions and countries in Africa, the result from this meta-analysis can serve as a benchmark for future studies until more relevant data are reported.
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Affiliation(s)
| | - Oyinlola P Fasina
- Cardiothoracic Surgery, Surgery Interest Group of Africa, Lagos, NGA
| | - Tijani S Adiat
- Cardiothoracic Surgery, Surgery Interest Group of Africa, Lagos, NGA
| | - Promise U Nwosu
- Cardiothoracic Surgery, Surgery Interest Group of Africa, Lagos, NGA
| | | | - Bukola G Adu
- Cardiothoracic Surgery, Surgery Interest Group of Africa, Lagos, NGA
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Sperry BW, Bateman TM, Akin EA, Bravo PE, Chen W, Dilsizian V, Hyafil F, Khor YM, Miller RJH, Slart RHJA, Slomka P, Verberne H, Miller EJ, Liu C. Hot spot imaging in cardiovascular diseases: an information statement from SNMMI, ASNC, and EANM. J Nucl Cardiol 2023; 30:626-652. [PMID: 35864433 DOI: 10.1007/s12350-022-02985-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/19/2022] [Indexed: 11/30/2022]
Abstract
This information statement from the Society of Nuclear Medicine and Molecular Imaging, American Society of Nuclear Cardiology, and European Association of Nuclear Medicine describes the performance, interpretation, and reporting of hot spot imaging in nuclear cardiology. The field of nuclear cardiology has historically focused on cold spot imaging for the interpretation of myocardial ischemia and infarction. Hot spot imaging has been an important part of nuclear medicine, particularly for oncology or infection indications, and the use of hot spot imaging in nuclear cardiology continues to expand. This document focuses on image acquisition and processing, methods of quantification, indications, protocols, and reporting of hot spot imaging. Indications discussed include myocardial viability, myocardial inflammation, device or valve infection, large vessel vasculitis, valve calcification and vulnerable plaques, and cardiac amyloidosis. This document contextualizes the foundations of image quantification and highlights reporting in each indication for the cardiac nuclear imager.
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Affiliation(s)
- Brett W Sperry
- Saint Luke's Mid America Heart Institute, 4401 Wornall Rd, Suite 2000, Kansas City, MO, 64111, USA.
| | - Timothy M Bateman
- Saint Luke's Mid America Heart Institute, 4401 Wornall Rd, Suite 2000, Kansas City, MO, 64111, USA
| | - Esma A Akin
- George Washington University Hospital, Washington, DC, USA
| | - Paco E Bravo
- Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Wengen Chen
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Fabien Hyafil
- Department of Nuclear Medicine, Hôpital Européen Georges-Pompidou, DMU IMAGINA, Assistance Publique -Hôpitaux de Paris, University of Paris, Paris, France
| | - Yiu Ming Khor
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore, Singapore
| | - Robert J H Miller
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands
| | - Piotr Slomka
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Hein Verberne
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Edward J Miller
- Department of Radiology and Biomedical Imaging, Yale University, 801 Howard Ave, New Haven, CT, 06519, USA
| | - Chi Liu
- Department of Radiology and Biomedical Imaging, Yale University, 801 Howard Ave, New Haven, CT, 06519, USA.
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Wang S, Lyu Y, Cheng S, Zhang Y, Gu X, Gong M, Liu J. Smaller left ventricular end-systolic diameter and lower ejection fraction at baseline associated with greater ejection fraction improvement after revascularization among patients with left ventricular dysfunction. Front Cardiovasc Med 2022; 9:967039. [PMID: 36247459 PMCID: PMC9559822 DOI: 10.3389/fcvm.2022.967039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 09/13/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives To investigate the predictive roles of pre-operative left ventricular (LV) size and ejection fraction (EF) in EF improvement and outcome following revascularization in patients with coronary artery disease (CAD) and LV dysfunction. Background Revascularization may improve EF and long-term outcomes of patients with LV dysfunction. However, the determinants of EF improvement have not yet been investigated comprehensively. Materials and methods Patients with EF measurements before and 3 months after revascularization were enrolled in a cohort study (No. ChiCTR2100044378). All patients had baseline EF ≤ 40%. EF improvement was defined as absolute increase in EF > 5%. According to LV end-systolic diameter (LVESD) (severely enlarged or not) and EF (≤35% or of 36–40%) at baseline, patients were categorized into four groups. Results A total of 939 patients were identified. A total of 549 (58.5%) had EF improved. Both LVESD [odds ratio (OR) per 1 mm decrease, 1.05; 95% CI, 1.04–1.07; P < 0.001] and EF (OR per 1% decrease, 1.06; 95% CI, 1.03–1.10; P < 0.001) at baseline were predictive of EF improvement after revascularization. Patients with LVESD not severely enlarged and EF ≤ 35% had higher odds of being in the EF improved group in comparison with other three groups both in unadjusted and adjusted analysis (all P < 0.001). The median follow-up time was 3.5 years. Patients with LVESD not severely enlarged and EF ≤ 35% had significantly lower risk of all-cause death in comparison with patients with LVESD severely enlarged and EF ≤ 35% [hazard ratio (HR), 2.73; 95% CI, 1.28–5.82; P = 0.009], and tended to have lower risk in comparison with patients with LVESD severely enlarged and EF of 36–40% (HR, 2.00; 95% CI, 0.93–4.27; P = 0.074). Conclusion Among CAD patients with reduced EF (≤ 40%) who underwent revascularization, smaller pre-operative LVESD and lower EF had greatest potential to have EF improvement and better outcome. Our findings imply the indication for revascularization in patients with LV dysfunction who presented with lower EF but smaller LV size.
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Affiliation(s)
- Shaoping Wang
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China
| | - Yi Lyu
- Department of Anesthesiology, Minhang Hospital, Fudan University, Shanghai, China
| | - Shujuan Cheng
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China
| | - Yuchao Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China
| | - Xiaoyan Gu
- Department of Echocardiography, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China
| | - Ming Gong
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China
| | - Jinghua Liu
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China
- *Correspondence: Jinghua Liu,
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Ntinopoulos V, Papadopoulos N, Odavic D, Haeussler A, Dzemali O. Ejection Fraction Recovery after Coronary Artery Bypass Grafting for Ischemic Cardiomyopathy. Thorac Cardiovasc Surg 2021; 70:544-548. [PMID: 34894634 DOI: 10.1055/s-0041-1736246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Controversy exists about left ventricular systolic function recovery after coronary artery bypass grafting in patients with ischemic cardiomyopathy. The aim of this study is to evaluate the temporal evolvement of left ventricular systolic function after coronary artery bypass surgery in patients with ischemic cardiomyopathy. PATIENTS AND METHODS A total of 50 patients with coronary artery disease and left ventricular ejection fraction (LVEF) ≤35% underwent isolated coronary artery bypass grafting in a single center in the period 2017 to 2019. We performed a retrospective analysis of the echocardiographic and clinical follow-up data at 3 months and 1 year postoperatively. RESULTS Median LVEF preoperatively was 25% (20-33%), mean patient age was 66 ± 8.2 years, 33 (66%) patients were operated off-pump, and 22 (44%) procedures were non-elective. There was no in-hospital myocardial infarction, stroke, and repeat revascularization. Three (6%) patients underwent re-exploration for bleeding or tamponade. In-hospital mortality was 8% and 1-year mortality was 12%. At 1 year postoperatively, there was no repeat revascularization, no myocardial infarction, 1 (2.6%) patient had a transient ischemic attack, and 10 (20%) patients required an implantable defibrillator. There was a statistically significant median ejection fraction increase at 3 months (15% [5-22%], p < 0.0001) and 1 year (23% [13-25%], p < 0.0001) postoperatively, with an absolute increase ≥10% in 32 (74.4%) and 30 (78.9%) patients at 3 months and 1 year, respectively. CONCLUSION Patients with ischemic cardiomyopathy undergoing coronary artery bypass surgery show continuous recovery of left ventricular systolic function in the first postoperative year.
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Affiliation(s)
| | | | - Dragan Odavic
- Department of Cardiac Surgery, Municipal Hospital Triemli, Zurich, Switzerland
| | - Achim Haeussler
- Department of Cardiac Surgery, Municipal Hospital Triemli, Zurich, Switzerland
| | - Omer Dzemali
- Department of Cardiac Surgery, Municipal Hospital Triemli, Zurich, Switzerland
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Ananthanarayanan C, Patel K, Wadhawa V, Patel A, Doshi C, Kothari J, Shah P. Midterm outcome of off-pump CABG for severe LV dysfunction-Does LV size and function predict their midterm outcome? J Card Surg 2021; 36:1000-1009. [PMID: 33503684 DOI: 10.1111/jocs.15362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/12/2020] [Accepted: 12/12/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The superiority of surgical revascularization in ischemic cardiomyopathy is established beyond doubt, and off-pump CABG (OP-CABG) is a safe way of revascularization in this high-risk subset. Data on the effect of postoperative ventricular function and size on their midterm outcome is scarce. MATERIALS AND METHODS A retrospective study was done on 211 consecutive patients with severe LV dysfunction who underwent OP-CABG from January 2017 to December 2018. Data were collected from the institutional database. Their operative and midterm outcomes were statistically analyzed. RESULTS The mean age of the cohort was 58.4 ± 8.3 years. An average number of grafts was 3.1 ± 0.8 (cumulative intended number of grafts-3). Operative mortality was 10.9%. Preoperative NYHA class (p < .0001; OR, 19.72) and postoperative IABP insertion (p < .008; OR, 88.75) were independent predictors of operative mortality. The mean follow-up period was 3.14 ± 0.07 years, was 97.4% complete with cardiac mortality of 5.8%. Postoperative LVEF (p = .002; OR, 0.868) and LV dimensions (systole & diastole) (p = .013, OR = 1.182 and p = .036, OR = 1.184, respectively) were independent predictors of midterm mortality. Midterm major adverse cardiovascular event-free survival of operative survivors was 89%. There was no correlation between postoperative LV dimension and NYHA status(p > .05). Myocardial viability was not associated with early (p = .17) or midterm mortality (p = .676). CONCLUSION OP-CABG can achieve complete revascularization in patients with severe LV dysfunction with good midterm outcomes, albeit with high early operative mortality. Postoperative change in LV dimension and EF are predictors of midterm mortality.
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Affiliation(s)
- Chandrasekaran Ananthanarayanan
- Department of CVTS, U. N. Mehta Institute of Cardiology and Research Center (affiliated to BJ Medical College, Ahmedabad), Ahmedabad, Gujarat, India
| | - Kartik Patel
- Department of CVTS, U. N. Mehta Institute of Cardiology and Research Center (affiliated to BJ Medical College, Ahmedabad), Ahmedabad, Gujarat, India
| | - Vivek Wadhawa
- Department of CVTS, U. N. Mehta Institute of Cardiology and Research Center (affiliated to BJ Medical College, Ahmedabad), Ahmedabad, Gujarat, India
| | - Archit Patel
- Department of CVTS, U. N. Mehta Institute of Cardiology and Research Center (affiliated to BJ Medical College, Ahmedabad), Ahmedabad, Gujarat, India
| | - Chirag Doshi
- Department of CVTS, U. N. Mehta Institute of Cardiology and Research Center (affiliated to BJ Medical College, Ahmedabad), Ahmedabad, Gujarat, India
| | - Jignesh Kothari
- Department of CVTS, U. N. Mehta Institute of Cardiology and Research Center (affiliated to BJ Medical College, Ahmedabad), Ahmedabad, Gujarat, India
| | - Pratik Shah
- Department of CVTS, U. N. Mehta Institute of Cardiology and Research Center (affiliated to BJ Medical College, Ahmedabad), Ahmedabad, Gujarat, India
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Jose R, Shetty A, Krishna N, Chathoth V, Bhaskaran R, Jayant A, Varma PK. Early and Mid-Term Outcomes of Patients Undergoing Coronary Artery Bypass Grafting in Ischemic Cardiomyopathy. J Am Heart Assoc 2019; 8:e010225. [PMID: 31072240 PMCID: PMC6585328 DOI: 10.1161/jaha.118.010225] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 04/17/2019] [Indexed: 01/18/2023]
Abstract
Background Many observational studies and trials have shown that coronary artery bypass grafting improves the survival in patients with ischemic cardiomyopathy. However, these results are based on data generated from developed countries. Poor socioeconomic statuses, lack of uniformity in healthcare delivery, differences in risk profile, and affordability to access optimal health care are some factors that make the conclusions from these studies irrelevant to patients from India. Methods and Results One-hundred and sixty-two patients with severe left ventricular dysfunction (ejection fraction ≤35%) who underwent coronary artery bypass grafting from 2009 to 2017 were enrolled for this study. Mean age of the study population was 58.67±9.70 years. Operative mortality was 11.62%. Thirty day/in-house composite outcome of stroke and perioperative myocardial infarction were 5.8%. The percentage of survival for 1 year was 86.6%, and 5-year survival was 79.9%. Five-year event-free survival was 49.3%. The mean ejection fraction improved from 30.7±4.08% (range 18-35) to 39.9±8.3% (range 24-60). Lack of improvement of left ventricular function was a strong predictor of late mortality (hazard ratio, 21.41; CI 4.33-105.95). Even though there was a trend towards better early outcome in off-pump CABG , the 5-year survival rates were similar in off-pump and on-pump group (73.4% and 78.9%, respectively; P value 0.356). Conclusions We showed that coronary artery bypass grafting in ischemic cardiomyopathy was associated with high early composite outcomes. However, the 5-year survival rates were good. Lack of improvement of left ventricular function was a strong predictor of late mortality.
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Affiliation(s)
- Rajesh Jose
- Division of Cardiothoracic SurgeryAmrita Institute of Medical Sciences and Research CenterAmrita Viswa Vidyapeetham (Amrita University)KochiIndia
| | - Ashith Shetty
- Division of Cardiothoracic SurgeryAmrita Institute of Medical Sciences and Research CenterAmrita Viswa Vidyapeetham (Amrita University)KochiIndia
| | - Neethu Krishna
- Division of Cardiothoracic SurgeryAmrita Institute of Medical Sciences and Research CenterAmrita Viswa Vidyapeetham (Amrita University)KochiIndia
| | - Vijisha Chathoth
- Division of Cardiothoracic SurgeryAmrita Institute of Medical Sciences and Research CenterAmrita Viswa Vidyapeetham (Amrita University)KochiIndia
| | - Renjitha Bhaskaran
- Division of BiostatisticsAmrita Institute of Medical Sciences and Research CenterAmrita Viswa Vidyapeetham (Amrita University)KochiIndia
| | - Aveek Jayant
- Division of AnesthesiologyAmrita Institute of Medical sciences and Research centerAmrita Viswa Vidyapeetham (Amrita University)KochiIndia
| | - Praveen Kerala Varma
- Division of Cardiothoracic SurgeryAmrita Institute of Medical Sciences and Research CenterAmrita Viswa Vidyapeetham (Amrita University)KochiIndia
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