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Zhu Z, Li Y, Zhang F, Steiger S, Guo C, Liu N, Lu J, Fan G, Wu W, Wu M, Wang H, Xu D, Chen Y, Zhu J, Meng X, Hou X, Anders HJ, Ye J, Zheng Z, Li C, Zhang H. Prediction of Male Coronary Artery Bypass Grafting Outcomes Using Body Surface Area Weighted Left Ventricular End-diastolic Diameter: Multicenter Retrospective Cohort Study. Interact J Med Res 2023; 12:e45898. [PMID: 36951893 PMCID: PMC10131828 DOI: 10.2196/45898] [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: 01/20/2023] [Revised: 02/10/2023] [Accepted: 02/21/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND The presence of a high left ventricular end-diastolic diameter (LVEDD) has been linked to a less favorable outcome in patients undergoing coronary artery bypass grafting (CABG) procedures. However, by taking into consideration the reference of left ventricular size and volume measurements relative to the patient's body surface area (BSA), it has been suggested that the accuracy of the predicting outcomes may be improved. OBJECTIVE We propose that BSA weighted LVEDD (bLVEDD) is a more accurate predictor of outcomes in patients undergoing CABG compared to simply using LVEDD alone. METHODS This study was a comprehensive retrospective cohort study that was conducted across multiple medical centers. The inclusion criteria for this study were patients who were admitted for treatment between October 2016 and May 2021. Only elective surgery patients were included in the study, while those undergoing emergency surgery were not considered. All participants in the study received standard care, and their clinical data were collected through the institutional registry in accordance with the guidelines set forth by the Society of Thoracic Surgeons National Adult Cardiac Database. bLVEDD was defined as LVEDD divided by BSA. The primary outcome was in-hospital all-cause mortality (30 days), and the secondary outcomes were postoperative severe adverse events, including use of extracorporeal membrane oxygenation, multiorgan failure, use of intra-aortic balloon pump, postoperative stroke, and postoperative myocardial infarction. RESULTS In total, 9474 patients from 5 centers under the Chinese Cardiac Surgery Registry were eligible for analysis. We found that a high LVEDD was a negative factor for male patients' mortality (odds ratio 1.44, P<.001) and secondary outcomes. For female patients, LVEDD was associated with secondary outcomes but did not reach statistical differences for morality. bLVEDD showed a strong association with postsurgery mortality (odds ratio 2.70, P<.001), and secondary outcomes changed in parallel with bLVEDD in male patients. However, bLVEDD did not reach statistical differences when fitting either mortality or severer outcomes in female patients. In male patients, the categorical bLVEDD showed high power to predict mortality (area under the curve [AUC] 0.71, P<.001) while BSA (AUC 0.62) and LVEDD (AUC 0.64) both contributed to the risk of mortality but were not as significant as bLVEDD (P<.001). CONCLUSIONS bLVEDD is an important predictor for male mortality in CABG, removing the bias of BSA and showing a strong capability to accurately predict mortality outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT02400125; https://clinicaltrials.gov/ct2/show/NCT02400125.
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Affiliation(s)
- Zhihui Zhu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Medizinische Klinik und Poliklinik IV, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Yuehuan Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Fan Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Stefanie Steiger
- Medizinische Klinik und Poliklinik IV, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Cheng Guo
- Allianz Technology, Allianz, Munich, Germany
| | - Nan Liu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jiakai Lu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Guangpu Fan
- Department of Cardiovascular Surgery, Peking University People's Hospital, Beijing, China
| | - Wenbo Wu
- Department of Cardiovascular Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Mingying Wu
- Department of Cardiovascular Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Huaibin Wang
- Department of Cardiovascular Surgery, Beijing Hospital, Beijing, China
| | - Dong Xu
- Department of Cardiovascular Surgery, Beijing Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yu Chen
- Department of Cardiovascular Surgery, Peking University People's Hospital, Beijing, China
| | - Junming Zhu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xu Meng
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaotong Hou
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hans-Joachim Anders
- Medizinische Klinik und Poliklinik IV, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Jian Ye
- Department of Cardiovascular Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Zhe Zheng
- Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Chenyu Li
- Medizinische Klinik und Poliklinik IV, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Haibo Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Xin H, Zhu M. Imaging options for defining anomalous origin of the coronary artery from the pulmonary artery. Quant Imaging Med Surg 2023; 13:1164-1173. [PMID: 36819256 PMCID: PMC9929387 DOI: 10.21037/qims-22-502] [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: 05/18/2022] [Accepted: 10/18/2022] [Indexed: 11/15/2022]
Abstract
Anomalous origin of the coronary artery from the pulmonary artery is a rare type of congenital heart disease (CHD). According to the establishment of collateral circulation and the abnormal anatomy of coronary arteries, there are several clinical types. In some clinical types, serious cardiac insufficiency can arise in the early stage of the condition, which, if not promptly treated, can endanger the patient's life. Up to 90% of infants with an anomaly involving the left coronary artery die within the first year of life. The treatment of the disease is to restore the double coronary circulation as soon as possible by surgery after early detection by diagnostic imaging. Presently, medical imaging is the most commonly used examination method for a diagnosis of the disease. The comprehensive application of various imaging modalities is the basis for the diagnosis and follow-up of coronary artery origin from the pulmonary artery. The current review mainly summarized the common signs and application advantages of different imaging techniques in the diagnosis of anomalous origin of the coronary artery from the pulmonary artery. It also highlights existing problems and provides an important theoretical basis and practical guidance for imaging techniques about the coronary artery originating from the pulmonary artery's diagnosis and treatment.
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Affiliation(s)
- Hao Xin
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Mei Zhu
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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Wang H, Zhang B, Wu WC, Zhu ZH, Wang H. Change of Left Ventricular Geometric Pattern in Patients with Preserved Ejection Fraction Undergoing Coronary Artery Bypass Grafting. J Cardiovasc Transl Res 2022; 15:1444-1454. [PMID: 35543834 DOI: 10.1007/s12265-022-10249-6] [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] [Received: 12/06/2021] [Accepted: 03/31/2022] [Indexed: 12/16/2022]
Abstract
Left ventricular (LV) remodeling and geometric patterns are associated with variations in prognosis. Two hundred twenty-eight patients who underwent selective isolated coronary artery bypass grafting (CABG) were included, divided into normal geometry, concentric remodeling, concentric hypertrophy, and eccentric hypertrophy at baseline. More than half participants with normal geometry at baseline remained in that category, and similar ratio of concentric remodeling reverted to normal geometry on follow-up. The concentric hypertrophy at baseline tended to progress to eccentric geometry rather than normal geometry, while changes from eccentric to concentric hypertrophy was uncommon. iLVEDD had a significant association with an increased risk of developing an abnormal geometric pattern from a normal or concentric remodeling pattern, and iLVESD and LAScd involved in the regression from an abnormal geometric pattern. Thus, dynamic changes in LV geometric pattern are common on 1-year follow-up after CABG and LA strain has an incremental role for early detection in this process.
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Affiliation(s)
- Han Wang
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Road, XiCheng District, Beijing, 100037, People's Republic of China
| | - Bing Zhang
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Road, XiCheng District, Beijing, 100037, People's Republic of China
| | - Wei-Chun Wu
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Road, XiCheng District, Beijing, 100037, People's Republic of China
| | - Zhen-Hui Zhu
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Road, XiCheng District, Beijing, 100037, People's Republic of China
| | - Hao Wang
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Road, XiCheng District, Beijing, 100037, People's Republic of China.
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Goeddel LA, Grant MC. Preoperative Evaluation and Cardiac Risk Assessment in Vascular Surgery. Anesthesiol Clin 2022; 40:575-585. [PMID: 36328616 DOI: 10.1016/j.anclin.2022.08.005] [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] [Indexed: 06/16/2023]
Abstract
We summarize epidemiologic trends, outcomes, and preoperative guidelines for vascular surgery patients from 2010 to 2022. Vascular surgery continues to evolve in technology and engineering to treat a surgical population that suffers from a high prevalence of comorbidities. Preoperative optimization seeks to characterize the burden of disease and to achieve medical control in the timeline available before surgery. Risk assessment, evaluation, optimization, and prediction of major adverse cardiac events is an evolving science where the Vascular Surgery Quality Initiative has made an impact. Ongoing investigation may demonstrate value for preoperative echocardiography, functional capacity, frailty, and mobility assessments.
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Affiliation(s)
- Lee A Goeddel
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins School of Medicine, Zayed 6208J, 1800 Orleans, Baltimore, MD 21287, USA.
| | - Michael C Grant
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins School of Medicine, Zayed 6208J, 1800 Orleans, Baltimore, MD 21287, USA
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Yan P, Zhang K, Cao J, Dong R. Left Ventricular Structure is Associated with Postoperative Death After Coronary Artery Bypass Grafting in Patients with Heart Failure with Reduced Ejection Fraction. Int J Gen Med 2022; 15:53-62. [PMID: 35018113 PMCID: PMC8742600 DOI: 10.2147/ijgm.s341145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/01/2021] [Indexed: 12/22/2022] Open
Abstract
Background The relationship between abnormal left ventricular (LV) structure and adverse outcomes has been confirmed in diverse patient groups in previous studies. However, it remains uncertain whether LV structure has predictive implications in heart failure with reduced ejection fraction (HFrEF) patients with coronary artery bypass grafting (CABG). Methods This study retrospectively enrolled patients who had HFrEF and underwent CABG between January 2013 and July 2019. According to LV hypertrophy (LVH) and LV enlargement (LVE) assessed by echocardiography, patients were classified into four LV structure types: (-)LVH/(-)LVE, (+)LVH/(-)LVE, (-)LVH/(+)LVE, and (+)LVH/(+)LVE. Results A total of 435 consecutive patients (mean age: 59.4 ± 9.6 years; 14.9% female) were enrolled in the present study. Examined independently, either LVH (p < 0.001) or LVE (p < 0.001) was independently associated with postoperative mortality in multivariate analysis. When LVH and LVE were analyzed in combination, the risk of mortality after CABG was lowest in (-)LVH/(-)LVE and increased with (+)LVH/(-)LVE (odds ratio [OR]: 7.525; 95% confidence interval [CI]: 1.827–30.679, p = 0.004), (-)LVH/(+)LVE (OR: 7.253; 95% CI: 1.950–27.185, p = 0.003), and (+)LVH/(+)LVE (OR: 9.547; 95% CI: 2.726–34.805, p < 0.001), independent of other risk factors. Adding LV structural types to the baseline model gained an incremental effect on the predictive value for postoperative mortality (AUC: baseline model, 0.838 vs baseline model + LV structural types, 0.901, p for comparison = 0.010; category‐free net reclassification improvement (NRI): 0.764, p < 0.001; integrated discrimination improvement (IDI): 0.061, p = 0.007). Conclusion LVH and LVE were associated with an increased risk of postoperative mortality after CABG in patients with HFrEF. Categorizing LV structural patterns with LVH and LVE contributes to risk stratification and provides incremental predictive ability. Routine echocardiographic assessment of LVH and LVE is needed in clinical practice.
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Affiliation(s)
- Pengyun Yan
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Kui Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Jian Cao
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Ran Dong
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
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Li T, Li G, Guo X, Li Z, Sun Y. Echocardiographic left ventricular geometry profiles for prediction of stroke, coronary heart disease and all-cause mortality in the Chinese community: a rural cohort population study. BMC Cardiovasc Disord 2021; 21:238. [PMID: 33980151 PMCID: PMC8114526 DOI: 10.1186/s12872-021-02055-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/07/2021] [Indexed: 01/19/2023] Open
Abstract
Background The utility of echocardiographic left ventricular (LV) geometry in the prediction of stroke/coronary heart disease (CHD) and all-cause mortality is not well characterized. This study aimed to evaluate the overall and sex-specific prognostic value of different geometric patterns on the incidence of stroke/CHD and all-cause mortality in a Chinese population-based cohort. Methods We conducted a prospective study in the general population in Northeast China, and a total of 9940 participants aged ≥ 35 years underwent echocardiography for LV geometry and were successfully followed up for incident stroke/CHD and all-cause death. Cox proportional hazards models were utilized to estimate the association of baseline LV geometry with adverse outcomes. Results Over a median follow-up of 4.66 years, abnormal LV geometric patterns had increased crude incident rates of stroke/CHD and all-cause mortality compared with normal geometry in overall population and each sex group (all P < 0.05). Multivariable Cox analysis reported that LV concentric and eccentric hypertrophy were associated with incident stroke/CHD (concentric hypertrophy: hazard ratio (HR) = 1.39, 95% confidence interval (CI) = 1.04–1.86; eccentric hypertrophy: HR = 1.42, 95% CI = 1.11–1.82) and all-cause mortality (concentric hypertrophy: HR = 1.50, 95% CI = 1.07–2.12; eccentric hypertrophy: HR = 1.58, 95% CI = 1.19–2.10), and LV concentric remodeling was related to stroke/CHD incidence (HR = 1.42, 95% CI = 1.09–1.84) in total population compared to normal geometry after the adjustment for potential confounders. In men, a significant increase was observed from LV eccentric hypertrophy for incident stroke/CHD, whereas in women, LV concentric hypertrophy was associated with elevated incidence of both stroke/CHD and all-cause death, and eccentric hypertrophy was correlated with increased all-cause mortality (all P < 0.05). Conclusions Our prospective cohort supports that abnormal LV geometry by echocardiography has a prognostic significance for incident stroke/CHD and all-cause mortality, implying that early detection and intervention of LV structural remodeling in rural China are urgently needed to prevent adverse outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02055-w.
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Affiliation(s)
- Tan Li
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, 110001, People's Republic of China
| | - Guangxiao Li
- Department of Medical Record Management Center, The First Hospital of China Medical University, Shenyang, 110001, People's Republic of China
| | - Xiaofan Guo
- Department of Cardiology, The First Hospital of China Medical University, No.155 Nanjing Bei Street, Heping District, Shenyang, 110001, Liaoning Province, People's Republic of China
| | - Zhao Li
- Department of Cardiology, The First Hospital of China Medical University, No.155 Nanjing Bei Street, Heping District, Shenyang, 110001, Liaoning Province, People's Republic of China
| | - Yingxian Sun
- Department of Cardiology, The First Hospital of China Medical University, No.155 Nanjing Bei Street, Heping District, Shenyang, 110001, Liaoning Province, People's Republic of China.
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