Association of Both High and Low Left Ventricular Ejection Fraction With Increased Risk After Coronary Artery Bypass Grafting

Maile, Michael D.; Mathis, Michael R.; Habib, Robert H.; Schwann, Thomas A.; Engoren, Milo

doi:10.1016/j.hlc.2020.11.005

Cited by 4 publications

(2 citation statements)

References 29 publications

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“…The results of the above study found the technique and prognosis of CABG in patients with coronary heart disease and left ventricular failure were significant, but the recovery of ejection fraction after CABG was slower and it also was related to whether the ejection fraction was high or normal before surgery, with a high preoperative LVEF value associated with an increased patient risk. It previously was thought that low left ventricular ejection fraction was associated with CABG, but the findings of this study showed that high ejection fraction was associated with CABG surgery risk [Maile 2021]. Similarly, Zhang et al [Zhang 2021] performed CABG on patients with left ventricular systolic dysfunction and coronary heart disease and found there was no significant difference in death, during hospitalization, between patients with normal left ventricular systolic function and mild systolic dysfunction.…”

Section: Discussionmentioning

confidence: 60%

Effects of Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting on Clinical Outcomes in Patients with Reduced Ejection Fraction Heart Failure and Coronary Heart Disease: A Meta-Analysis

Zhou¹,

Jiang²,

Wang³

et al. 2023

HSF

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Objective: To clarify the effects of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) on the clinical outcomes of patients with coronary heart disease (CHD) complicated with reduced ejection fraction heart failure (HFrEF) through meta-analysis. Methods: Three major literature databases – PubMed, Web of Science, and Cochrane – were searched by search terms and the literature retrieval time was publications dating from January 2007 to December 2021. To search for observational studies and randomized controlled trials (RCT) comparing the efficacy of PCI and CABG in patients with CHD and HFrEF, the abstract or full text of the literature was read and the final included literature was determined, according to inclusion and exclusion criteria. The quality of the included literature was evaluated using the Ottawa scale and data extraction was further completed. Data analysis was made using RevMan5.4 and R4.1 software; relevant forest plots and funnel plots were made, according to the extracted data. Egger’s test was used to evaluate whether the data had publication bias. Outcomes were the major adverse cardiovascular events (MACE). Results: A total of 10 studies were included and 11,032 subjects were included, made up of 5,521 cases of PCI and 5,511 cases of CABG. The results showed no significant difference between the two groups in cardiac mortality (CM) (RR=1.13, 95% CI 0.98-1.30, P = 0.10) and in overall all-cause mortality (ACM) (RR=1.12, 95% CI 0.92-1.37, P = 0.25). In the subgroup analysis of ACM, in the subgroups with left ventricular ejection fraction (LVEF) less than 35% and exceeding 35% and less than 50% (RR=1.12, 95% CI 0.92-1.37, P = 0.25) between the two groups, there was no statistical difference. However, among other MACE, compared with the PCI group, the CABG group had a lower risk of MACE (RR=1.58, 95%CI 1.49-1.70, P < 0.00001), myocardial infarction (MI) (RR=1.99, 95% CI 1.02-3.88, P = 0.04), heart failure (HF) (RR=1.29, 95% CI 1.17-1.43, P < 0.00001) and revascularization (RR=2.74, 95% CI 1.93-3.90, P < 0.00001). Finally in the CABG group, the risk of stroke or transient ischemic attack (TIA) was higher (RR=0.71, 95% CI 0.58-0.86, P = 0.0006) than the PCI group. Conclusions: The mortality rates of PCI and CABG were similar in patients with CHD complicated with HFrEF. Compared with PCI, CABG had a lower incidence of MACE, MI, HF, and revascularization, and a higher incidence of stroke or TIA.

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Section: Discussionmentioning

confidence: 60%

Effects of Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting on Clinical Outcomes in Patients with Reduced Ejection Fraction Heart Failure and Coronary Heart Disease: A Meta-Analysis

Zhou¹,

Jiang²,

Wang³

et al. 2023

HSF

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“…28,29 Therefore, event risk assessment is an important step during the work-up since it has a major impact on the subsequent therapeutic decisions. Although reduced systolic function, typically quantified as LVEF, is a known risk factor for adverse complications in CAD, 30 it has been reported that GLS but not LVEF is independently associated with risk of incident heart failure in patients admitted with CAD and provide incremental prognostic value to clinical model. 10 There are several potential reasons for the better prognostic value of longitudinal strain than LVEF.…”

Section: Discussionmentioning

confidence: 99%

Incremental prognostic utility of left ventricular and left atrial strains in coronary artery disease patients with reduced systolic function

Lu,

Zhu,

Zhou

et al. 2024

Echocardiography

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ObjectiveThis study aimed to investigate the predictive value of left ventricular global longitudinal strain (GLS) and left atrial reservoir strain (LARS) on adverse events in chronic coronary artery disease (CAD) patients with reduced systolic function.MethodsA total of 192 consecutive patients clinically diagnosed with chronic CAD and left ventricular ejection fraction (LVEF) ≤ 50% were finally included. Multiple strain parameters were analyzed with speckle tracking echocardiography. The composite endpoint included all‐cause mortality, rehospitalization due to heart failure, myocardial infarction, and stroke.ResultsPatients experiencing the endpoint showed lower LVEF, lower absolute GLS and LARS than those without events. Both GLS (AUC = 0.82 [GLS] vs. 0.58 [LVEF], p < 0.001) and LARS (AUC = 0.71 [LARS] vs. 0.58 [LVEF], p = 0.033) were superior to LVEF in predicting adverse events. Multivariate cox regression analysis showed that both GLS (hazard ratio, 0.71; 95% CI, 0.63–0.79; p < 0.001) and LARS (hazard ratio, 0.96; 95% CI, 0.93–0.98; p < 0.001) were independent predictors for the endpoint. The addition of LARS (global chi‐squared, 35.7 vs. 17.4; p < 0.05), GLS (global chi‐squared, 58.6 vs. 17.4; p < 0.05) or both LARS and GLS (global chi‐squared, 79.6 vs. 17.4; p < 0.05) to LVEF in the prediction model significantly improved its performance. The same significant improvement was also shown in the subgroups of mild (30% < LVEF ≤ 50%) and severe (LVEF ≤ 30%) reduced systolic function.ConclusionsRegarding CAD patients with reduced LVEF, both GLS and LARS are superior to LVEF in predicting adverse events, providing significant incremental value to LVEF.

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Risk factors of in-hospital mortality for isolated on-pump coronary artery bypass graft surgery in the northeast of Iran from 2007 to 2016

et al. 2023

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Association of Both High and Low Left Ventricular Ejection Fraction With Increased Risk After Coronary Artery Bypass Grafting

Cited by 4 publications

References 29 publications

Effects of Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting on Clinical Outcomes in Patients with Reduced Ejection Fraction Heart Failure and Coronary Heart Disease: A Meta-Analysis

Effects of Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting on Clinical Outcomes in Patients with Reduced Ejection Fraction Heart Failure and Coronary Heart Disease: A Meta-Analysis

Incremental prognostic utility of left ventricular and left atrial strains in coronary artery disease patients with reduced systolic function

Risk factors of in-hospital mortality for isolated on-pump coronary artery bypass graft surgery in the northeast of Iran from 2007 to 2016

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