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Belyaev AM, Skopin II, Lobacheva GV, Alshibaya MD. The combination of Euroscore II with a new variable "Nongraftable coronary artery lesions" improves the discriminating power of the test in surgical patients with postinfarction ventricular septal defect and ventricular aneurysm. J Card Surg 2022; 37:4952-4961. [PMID: 36378876 DOI: 10.1111/jocs.17181] [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: 07/05/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND We aimed to establish whether Euroscore II can be used for the prediction of hospital mortality in surgical patients with postinfarction intraventricular septal defect (PIVSD) and ventricular aneurysm (VA), and coexisting coronary artery lesions (CALs), and identify perioperative mortality risk factors to improve the discriminating power of Euroscore II. METHODS This was a retrospective observational study. The inclusion criterion was PIVSD. Exclusion criteria were previous CABG, conservative treatment, percutaneous transcatheter closure of PIVSDs, and PIVSDs with normal coronary arteries on coronary angiography. RESULTS Among 53 patients with PIVSDs and VAs who met eligibility criteria, 12 (22.6%) patients died in the hospital. Logistic regression demonstrated that Euroscore II was associated with in-hospital mortality (odds ratio [OR] = 1.13; 95% confidence interval [CI]: 1.03-1.23; p = .006), well-calibrated (Hosmer-Lemeshow χ2 (8) = 9.75; p = .283), and had fair discriminating power, area under receiver operating characteristic curve (AUC) = 77% (95% CI: 58%-96%). A newly identified variable "Nongraftable CALs" was associated with in-hospital mortality (OR = 6.65; 95% CI: 1.24-35.53; p = .027), and had a fair discriminating power, AUC = 70% (95% CI: 54%-85%). When Euroscore II and Nongraftable CALs were combined, the discriminating power of the test increased to 83% (95% CI: 71%-95%), p = .036. CONCLUSION Euroscore II has adequate discriminating power and good calibration in predicting in-hospital mortality of surgical patients with PIVSDs and VAs. The combination of Euroscore II with a new variable "Nongraftable CALs" significantly improves the performance of the model.
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Affiliation(s)
- Andrei M Belyaev
- Department of Surgical Treatment of Ischemic Heart Disease, Bakoulev's National Medical Research Centre for Cardiac Surgery, Moscow, Russia
| | - Ivan I Skopin
- Department of Surgical Treatment of Ischemic Heart Disease, Bakoulev's National Medical Research Centre for Cardiac Surgery, Moscow, Russia
| | - Galina V Lobacheva
- Intensive Care Unit, Department of Anesthesia and Intensive Care Medicine, Bakoulev's National Medical Research Centre for Cardiac Surgery, Moscow, Russia
| | - Mikhail D Alshibaya
- Department of Surgical Treatment of Ischemic Heart Disease, Bakoulev's National Medical Research Centre for Cardiac Surgery, Moscow, Russia
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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: 0] [Impact Index Per Article: 0] [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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Chen W, Ortiz-Leon XA, Posada-Martinez EL, Pereira J, Dewar ML, Darr U, Geirsson A, Sugeng L, Zhu Q. Acute changes of left ventricular function during surgical revascularization by 3D speckle tracking. Echocardiography 2021; 38:623-631. [PMID: 33740279 DOI: 10.1111/echo.15040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 02/25/2021] [Accepted: 03/10/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Detecting early impact of coronary artery bypass grafting (CABG) on left ventricular (LV) function is important because such measures may contribute to meaningful improvement in clinical outcomes. We aimed to gain knowledge about acute changes of LV performance during surgical revascularization using three-dimensional speckle tracking echocardiography (3D STE). METHODS Thirty-five patients scheduled for CABG surgery who underwent intraoperative transesophageal echocardiography (TEE) were enrolled (mean age 68.9 ± 7.3 years). TEE was performed before and after surgery, as well as before and after grafting. 3D LV ejection fraction (LVEF), tissue motion annular displacement (TMAD) of the mitral valves, 3D global longitudinal strain (GLS), global circumferential strain (GCS), twist, and torsion were quantified. Regional longitudinal strain (LS) was calculated based on coronary perfusion territories in a 16-segment LV model. RESULTS Despite the absence of change in TMAD and 3D LVEF, 3D GLS (-18.6 ± 4.3% at baseline vs -16.0 ± 4.0% after surgery, P = .01) was significantly decreased, followed with no significant effect on GCS, twist, and torsion during surgery. 3D GLS correlated significantly with 3D LVEF (r between -0.34 and -0.51, P < .05 for all) under the whole operation. Territorial LS did not increase immediately after surgery. CONCLUSION 3D speckle tracking imaging allows for detailed and direct evaluation of myocardial deformation, though impaired LV longitudinal function is still apparent immediately after surgery. GLS is more sensitive to an acute reduction in LV function than conventional parameters, which can be potentially useful for serial monitoring of functional recovery.
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Affiliation(s)
- Wanwen Chen
- Department of Cardiology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China.,Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA
| | - Xochitl A Ortiz-Leon
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | | | - Jason Pereira
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Michael L Dewar
- Section of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Umer Darr
- Section of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Arnar Geirsson
- Section of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Lissa Sugeng
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Qingbing Zhu
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA
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