Regional left ventricular function does not predict survival in ischaemic cardiomyopathy after cardiac surgery

Abstract

Objectives To define the prognostic contribution of global and regional left ventricular (LV) function measurements in patients with ischaemic cardiomyopathy randomised to coronary artery bypass graft surgery (CABG) with (N = 501) or without (N = 499) surgical ventricular reconstruction (SVR). Methods Novel multivariable methods to analyze global and regional LV systolic function were used to better formulate prediction models for long-term mortality following CABG with or without SVR in the entire cohort of 1000 randomised SVR hypothesis patients. Key clinical variables were included in the analysis. Regional function was classified according to the discreteness of anteroapical hypokinesia and akinesia into those most likely to benefit from SVR, those least likely and those felt to have intermediate likelihood of benefit from SVR. Results The most prognostic clinical variables identified in multivariable models include creatinine, LV end-systolic volume index (ESVI), age, and NYHA class. Addition of LV ejection fraction, LV end-diastolic volume index and regional function assessment did not contribute additional power to the model. Subgroup analysis based on regional function did not identify a cohort in which SVR improved mortality. Conclusions ESVI is the single parameter of LV function most predictive of mortality in patients with LV systolic dysfunction following CABG with or without SVR in multivariable models that include all key clinical and LV systolic function parameters. Assessment of regional cardiac function does not enhance prediction of mortality nor identify a subgroup for which SVR improves mortality. These results do not support elective addition of LV reconstruction surgery in patients undergoing CABG.

The authors’ reply to the letter from Kerkhof et al entitled ‘The importance of (measuring) the end-systolic volume index in predicting survival’

“…We thank Kerkhof et al 1 for their interest in our paper2 and are pleased they agree with our conclusion that accurate determination of end-systolic volume index (ESVI) is important in patients with reduced LVEF.

Table 3 and figure 2 show the entire range of ESVI values.

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Importance of (measuring) the end-systolic volume index in predicting survival

“…To the Editor  Prior et al 1 report on survival prediction in patients with ischaemic cardiomyopathy following surgical intervention and found that end-systolic volume (ESV) index (I) is the strongest indicator of survival. Their findings are partly based on an imputation procedure which is reported to have not affected the outcomes.…”

The results of standard echocardiography and use of Velocity Vector Imaging technology after surgical revascularization in patients with coronary artery disease

“…Оригинальные статьи ВВЕДЕНИЕ Стандартное эхокардиографическое (эхоКГ) исследование играет важную роль в диагностике ишемической болезни сердца (ИБС) и оценке функции миокарда левого желудочка (ЛЖ) до и после хирургической реваскуляризации. По данным литературы, показателями, влияющими на выживаемость пациентов в ранние и отдаленные сроки, являются: фракция выброса (ФВ), индекс конечно-систолического объема (КСО) ЛЖ, а также количество зон жизнеспособного миокарда [1][2][3][4]. При этом диастолическая функция (ДФ) рассматривается как ранний маркер ишемии [5][6][7][8].…”

“…При этом диастолическая функция (ДФ) рассматривается как ранний маркер ишемии [5][6][7][8]. Оценка сократительной функции при стандартном эхоКГ исследовании не несет существенной информации о прогнозе функции ЛЖ в послеоперационном периоде [4]. Это связано с тем, что сократимость -более сложный процесс, связанный с взаимодействием продольных, циркулярных и радиальных волокон, функцию которых при стандартном ультразвуковом исследовании визуально оценить невозможно [9].…”