1
|
Miric D, Bakovic D, Zanchi J, Bradaric Slujo A, Lozo M, Borovac JA. Myocardial work in patients with heart failure and ischemic cardiomyopathy according to the mode of coronary revascularization. Hellenic J Cardiol 2024; 78:16-24. [PMID: 37586481 DOI: 10.1016/j.hjc.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 08/10/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND The association of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) on myocardial function, as reflected in myocardial work (MyW) parameters, in patients with ischemic cardiomyopathy and heart failure (HF) is unknown. METHODS We analyzed data from 68 patients who were hospitalized with chronic HF due to ischemic cardiomyopathy and stratified them according to the mode of revascularization. All patients underwent a 2D speckle tracking echocardiography exam performed by the same expert sonographer and had complete MyW data including global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE). RESULTS The mean age of patients was 70 ± 10 years and 86.8% were men. The mean left ventricular ejection fraction (LVEF) in overall cohort was 31.6 ± 9.5%. Both subgroups did not significantly differ in terms of baseline LVEF, comorbidities, and pharmacotherapy. Compared with those who received PCI, patients revascularized with CABG had significantly greater GWI (821 vs. 555 mmHg%, p = 0.002), GCW (1101 vs. 794 mmHg%, p = 0.001), GWE (78 vs. 72.6%, p = 0.025), and global longitudinal strain (-8.7 vs. -6.7%, p = 0.004). Both patient subgroups did not significantly differ with respect to GWW (273 vs. 245 mmHg%, p = 0.410 for CABG and PCI, respectively) and survival during the median follow-up of 18 months (log-rank p = 0.813). CONCLUSION Patients with HF and ischemic cardiomyopathy revascularized with CABG had greater myocardial work performance when compared with those revascularized with PCI. This might suggest a higher degree of functional myocardial revascularization associated with the CABG procedure.
Collapse
Affiliation(s)
- Dino Miric
- Cardiovascular Diseases Department, University Hospital of Split, Split, Croatia
| | - Darija Bakovic
- Cardiovascular Diseases Department, University Hospital of Split, Split, Croatia; Department of Physiology, University of Split School of Medicine, Split, Croatia
| | - Jaksa Zanchi
- Cardiovascular Diseases Department, University Hospital of Split, Split, Croatia
| | - Anteo Bradaric Slujo
- Cardiovascular Diseases Department, University Hospital of Split, Split, Croatia; Department of Pathophysiology, University of Split School of Medicine, Split, Croatia
| | - Mislav Lozo
- Cardiovascular Diseases Department, University Hospital of Split, Split, Croatia
| | - Josip A Borovac
- Cardiovascular Diseases Department, University Hospital of Split, Split, Croatia; Department of Pathophysiology, University of Split School of Medicine, Split, Croatia.
| |
Collapse
|
2
|
Litwinowicz R, Mazur P, Śliwiński P, Bryndza M, Bartuś K, Filip G, Bartoszcze A, Piątek J, Konstanty-Kalandyk J, Kowalewski M, Ramaprabhu K, Hymczak H, Kapelak B, Kędziora A. Long-term survival following postoperative myocardial infraction after coronary artery bypass surgery. J Thorac Dis 2022; 14:102-112. [PMID: 35242372 PMCID: PMC8828518 DOI: 10.21037/jtd-21-1279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/22/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Postoperative myocardial infraction (MI) is a serious complication among patients undergoing Coronary Artery Bypass Grafting (CABG). Data on the impact of postoperative MI on patients undergoing CABG, specifically with respect to their long term outcomes are sparse. METHODS We retrospectively analyzed all patients who underwent isolated CABG between January 2014 and December 2016 and identified those who fulfilled the definition of the type 5MI following CABG according to the Fourth Universal Definition of Myocardial Infarction. RESULTS A total of 4,642 CABG patients were identified, of whom 141 (3.04%) were diagnosed with postoperative MI. The mean follow-up time was 5.1±2.07 years (range, 4.4-6.9 years). Postoperative MI was more common in patients with recent acute coronary syndrome, when compared to stable angina (22.8% vs. 31.9%; P=0.011) and in those with non-elective versus planned surgery (28.4% vs. 18.4%; P=0.003). Postoperative MI after CABG was associated with an increased rate of postoperative complications, including cardiac tamponade and re exploration for bleeding. Mortality after postoperative MI was higher at short-term follow-up (up to one year) and long-term follow-up (up to five years). The risk factors for postoperative MI after CABG were incomplete revascularization (IR) [OR (95% CI): 2.25 (1.59-3.12), P=0.001], non-elective surgery [OR (95% CI): 1.68 (1.10-2.54), P=0.015] and female gender [OR (95% CI): 1.48 (1.01-2.18), P=0.045]. CONCLUSIONS PMI after CABG is associated with reduced short- and long-term survival. The main risk factors for postoperative MI are IR, female gender, and non-elective surgery.
Collapse
Affiliation(s)
- Radosław Litwinowicz
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- The John Paul II Hospital, Krakow, Poland
| | - Piotr Mazur
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Magdalena Bryndza
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- The John Paul II Hospital, Krakow, Poland
| | - Krzysztof Bartuś
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- The John Paul II Hospital, Krakow, Poland
| | | | | | | | - Janusz Konstanty-Kalandyk
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- The John Paul II Hospital, Krakow, Poland
| | - Mariusz Kowalewski
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw, Poland
| | | | - Hubert Hymczak
- The John Paul II Hospital, Krakow, Poland
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | - Bogusław Kapelak
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- The John Paul II Hospital, Krakow, Poland
| | - Anna Kędziora
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- The John Paul II Hospital, Krakow, Poland
| |
Collapse
|
3
|
Jawitz OK, Lawton JS, Thibault D, O'Brien S, Higgins RSD, Schena S, Vemulapalli S, Thomas KL, Zwischenberger BA. Sex Differences in Coronary Artery Bypass Grafting Techniques: A STS Database Analysis. Ann Thorac Surg 2021; 113:1979-1988. [PMID: 34280377 DOI: 10.1016/j.athoracsur.2021.06.039] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/04/2021] [Accepted: 06/08/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Females with coronary artery disease (CAD) have inferior outcomes compared with males, including higher mortality following coronary artery bypass grafting (CABG). We aimed to evaluate the association of female sex with the use of guideline-concordant CABG revascularization techniques. METHODS The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database was queried for adult patients who underwent first-time isolated CABG in the US from 2011-2019. The association between female sex and the odds of (1) receiving a left internal mammary artery (LIMA) graft for revascularization of the left anterior descending (LAD) artery, (2) undergoing complete revascularization, and (3) undergoing multi-arterial grafting was assessed, adjusting for procedural anatomy. RESULTS Among 1,212,487 patients meeting inclusion criteria, 75% were male (n=911,178) and 25% were female (n=301,309). Female sex was associated with lower unadjusted rates of revascularization with an IMA (93.9% vs 95.9%, P<.001), bilateral IMA (2.9% vs 5.6%, P<.001) or radial artery (3.2% vs 5.6%, P<.001) graft. After adjustment, females had a lower odds than males of receiving a LIMA graft to the LAD (adjusted odds ratio [AOR] 0.79, 95% CI 0.75-0.83, P<.001), undergoing complete revascularization (AOR 0.86, 95% CI 0.83-0.90, P<.001), and undergoing multi-arterial grafting (AOR 0.78, 95% CI 0.75-0.81, P<.001). CONCLUSIONS Female sex was associated with a 14-22% lower odds of undergoing guideline concordant revascularization including LIMA to LAD grafting, multi-arterial grafting, and complete revascularization. Further investigation is necessary to determine why revascularization approaches differ by sex and to what degree sex disparities in CAD outcomes are due to surgical approach.
Collapse
Affiliation(s)
- Oliver K Jawitz
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
| | - Jennifer S Lawton
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Dylan Thibault
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Sean O'Brien
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Robert S D Higgins
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Stefano Schena
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Sreekanth Vemulapalli
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA; Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Kevin L Thomas
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA; Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Brittany A Zwischenberger
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
4
|
Residual angina in female patients after coronary revascularization. Int J Cardiol 2019; 286:208-213. [DOI: 10.1016/j.ijcard.2019.01.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/04/2019] [Accepted: 01/10/2019] [Indexed: 11/20/2022]
|
5
|
Vickneson K, Chan SP, Li Y, Bin Abdul Aziz MN, Luo HD, Kang GS, Caleb MG, Sorokin V. Coronary artery bypass grafting in patients with low ejection fraction: what are the risk factors? THE JOURNAL OF CARDIOVASCULAR SURGERY 2019; 60:396-405. [PMID: 30916532 DOI: 10.23736/s0021-9509.19.10670-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Left ventricular (LV) dysfunction alone is insufficient as an independent predictor of postoperative complications and mortality in coronary artery bypass graft (CABG) surgery. Our objective was to identify additional independent risk factors in patients with low left ventricle ejection fraction (EF) who underwent CABG. METHODS We retrospectively analyzed CABG results of 346 consecutive patients with low EF (≤30%) in a single institution between 2009 and 2015. The primary study endpoint was 30-day all-cause mortality. The secondary endpoints were the development of major adverse cardiac events (MACE) and renal complications after operation. A subgroup of patients underwent additional analyses of the interaction between extents of viable myocardium and postoperative endpoints. RESULTS The analysis showed that preoperative hemodynamic instability (AOR=4.57; 95% CI: 1.53-13.7, P=0.007) and serum creatinine >166 µmol/L (AOR=3.46; 95% CI: 1.12-10.7, P=0.031) were independent predictors of 30-day death. Both urgent and emergency operations were predictors for MACE (P=0.038; P=0.005) and renal complications (P=0.004; P=0.007). Pre-existing diabetes mellitus increased the likelihood of renal complications (P=0.020). In the sub-analysis of patients with viable myocardium, the mortality was significantly lower with predicted mortality (P=0.014). CONCLUSIONS Patients with significant LV dysfunction undergoing isolated CABG have fair short-term survival even with EF less than 30%. Hemodynamic instability prior to operation and preoperative kidney dysfunction are strong predictors of mortality in patients with low EF. Favorable coronary targets, meticulous operative techniques, and optimal surgical timing before hemodynamic deterioration occurs are essential to minimize the risk of revascularization complications and early postoperative mortality.
Collapse
Affiliation(s)
| | - Siew-Pang Chan
- Cardiovascular Research Institute, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Yue Li
- Department of Cardiac, Thoracic, and Vascular Surgery, National University Hospital, National University Health System, Singapore
| | | | - Hai D Luo
- Department of Cardiac, Thoracic, and Vascular Surgery, National University Hospital, National University Health System, Singapore
| | - Giap S Kang
- Department of Cardiac, Thoracic, and Vascular Surgery, National University Hospital, National University Health System, Singapore
| | - Michael G Caleb
- Department of Cardiac, Thoracic, and Vascular Surgery, National University Hospital, National University Health System, Singapore
| | - Vitaly Sorokin
- Department of Cardiac, Thoracic, and Vascular Surgery, National University Hospital, National University Health System, Singapore - .,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|