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Perioperative and postoperative predictors of outcome in patients with low ejection fraction early after coronary artery bypass grafting: the additional value of left ventricular remodeling.
- Source :
-
European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology [Eur J Cardiovasc Prev Rehabil] 2008 Aug; Vol. 15 (4), pp. 441-7. - Publication Year :
- 2008
-
Abstract
- Background: Scant data exist on factors that may identify outcome in patients with severe left ventricular (LV) dysfunction early after coronary artery bypass graft surgery (CABG).<br />Design: This study was designed to determine the prognostic value of clinical, operative, and postoperative factors in patients with LV dysfunction early after CABG.<br />Methods: In 333 consecutive patients with ejection fraction < or =35% on admission to residential cardiac rehabilitation after isolated CABG, potential preoperative, perioperative, and postoperative predictors of outcome, including 6-month LV remodeling, were recorded and patients followed up for a median of 3 years. The study end points were cardiovascular (CV) mortality and the combination of CV mortality and nonfatal CV events requiring hospitalization.<br />Results: The 3-year CV mortality-free survival and survival free of nonfatal CV event rates were 87 and 73%, respectively. Independent predictors of CV mortality were history of congestive heart failure [hazard ratio, HR: 2.8; 95% Confidence Interval (CI): 1.51-5.21], low ejection fraction on admission to cardiac rehabilitation (HR: 0.9; 95% CI: 0.87-0.96), and early complications after CABG (HR: 2.5; 95% CI: 1.23-5.15). When the combined end points were considered, postoperative left atrial size (HR: 1.07; 95% CI: 1.01-1.11), New York Heart Association class III or IV (HR: 1.69; 95% CI: 1.04-2.74), and 6-month remodeling (HR: 2.12; 95% CI: 1.33-3.36) were independent predictors.<br />Conclusion: Simple preoperative and postoperative variables may help identify patients with LV dysfunction early after CABG who are still at risk of major CV events. In this setting, 6-month LV remodeling is a strong predictor of a poor prognosis.
- Subjects :
- Aged
Cardiovascular Diseases mortality
Coronary Artery Disease complications
Coronary Artery Disease diagnostic imaging
Coronary Artery Disease surgery
Echocardiography
Female
Humans
Male
Middle Aged
Prognosis
Survival Analysis
Treatment Outcome
Ventricular Dysfunction, Left etiology
Coronary Artery Bypass adverse effects
Coronary Artery Bypass rehabilitation
Coronary Artery Disease physiopathology
Stroke Volume
Ventricular Remodeling
Subjects
Details
- Language :
- English
- ISSN :
- 1741-8267
- Volume :
- 15
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology
- Publication Type :
- Academic Journal
- Accession number :
- 18677169
- Full Text :
- https://doi.org/10.1097/HJR.0b013e3282f73501