Impact Of Right Ventricular Function For Worse Outcome After CABG With Or Without Surgical Ventricular Reconstruction
Sachiko Yamazaki, Hitoshi Yaku, Satoshi Numata, Keiichi Itatani, Kazuki Morimoto, Suguru Ohira, Haruka Fu.
Kyoto prefectural university of medicine, Kyoto, Japan.
OBJECTIVE: The prognostic value of right ventricular (RV) function for patients with ischemic cardiomyopathy (ICM) who underwent CABG with or without surgical ventricular reconstruction (SVR) was still unknown. The purpose of the study was to clarify whether cardiac MRI-derived RV assessment can facilitate risk stratification among patients who underwent CABG with or without SVR.
METHODS: We retrospectively analyzed 163 patients (109 men; age, 66 ± 10 years) with ICM, left ventricular ejection fraction (LVEF) 40% or less, who were evaluated using cardiac MRI preoperatively and underwent CABG with (n=53) or without (n=110) SVR from 2004 to 2014. Cine-MRI images had been acquired for left and RV volumetric measurements. Patients were divided into 2 groups; those with RVEF ≤ 35% (Group RF: n=38) and those with RVEF > 35% (Group C: n=125). The mid-term (median, 3.8 years) result of all cause death was evaluated, and interactions between RV function and treatment allocation were also analyzed.
RESULTS: Mean preoperative LVESVI was significantly larger (133 ± 44 vs. 90 ± 32 ml/m2, p<0.01) and LVEF were significantly lower (29 ± 8 vs. 18 ± 5%, p<0.01) in Group RF. Mean RVESVI was also significantly larger (64 ± 27 vs. 31 ± 9 ml/m2, p<0.01) and RVEF were lower (50 ± 7 vs. 26 ± 7%, p<0.01) in Group RF. Kaplan-Meier analysis showed that Group RF patients had greater but not significant incidence of all cause death (5 year; 66% vs. 78%, p=0.21). A significant interaction between RV dysfunction and treatment allocation was observed. Group RF patients who underwent CABG had similar incidences of all cause death (p=NS, figure A) compared with Group C patients who underwent CABG. However, Group RF patients who received CABG concomitant with SVR had significantly worse outcomes compared with group C patients who received concomitant SVR (p=0.013, figure B).
CONCLUSIONS: RV dysfunction may affect the mid-term outcome after CABG concomitant with SVR, despite it did not affect the outcome after CABG without SVR.
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