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Original research article
Regional left ventricular function does not predict survival in ischaemic cardiomyopathy after cardiac surgery
  1. David L Prior1,
  2. Susanna R Stevens2,
  3. Thomas A Holly3,
  4. Michal Krejca4,
  5. Alexandros Paraforos5,
  6. Gerald M Pohost6,
  7. Krysti Byrd2,
  8. Tomasz Kukulski7,
  9. Robert H Jones2,
  10. Patrice Desvigne-Nickens8,
  11. Padmini Varadarajan9,
  12. Aman Amanullah10,
  13. Grace Lin11,
  14. Hussein R Al-Khalidi2,
  15. Gabriel Aldea12,
  16. Carlo Santambrogio13,
  17. Andrzej Bochenek4,
  18. Daniel S Berman14
  1. 1 Department of Medicine, St. Vincent’s Hospital, University of Melbourne, Melbourne, Australia
  2. 2 Duke Clinical Research Institute (SRS,RHJ,HRA) and Department of Surgery Cardiothoracic (RHJ), Duke University School of Medicine, Durham, North Carolina, USA
  3. 3 Department of Medicine-Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  4. 4 1st Cardiac Surgery Department, Medical University of Silesia, Katowice, Poland
  5. 5 Department of Surgery-Cardiac, University of Trier, Trier, Germany
  6. 6 Department of Medicine-Cardiology, University of Southern California, Los Angeles, California, USA
  7. 7 Department of Cardiology, SMDZ in Zabrze, Medical University pf Silesia, Katowice, Silesian Center for Heart Diseases, Zabrze, Poland
  8. 8 National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
  9. 9 Department of Medicine-Cardiology, Loma Linda University Medical Center, Loma Linda, California, USA
  10. 10 Department of Medicine-Cardiology, Albert Einstein Medical Center, Philadelphia,Pennsylvania, USA
  11. 11 Department of Medicine-Cardiology, Mayo Clinic, Rochester,New York, USA
  12. 12 Department of Surgery-Cardiothoracic, University of Washington Medical Center, Seattle, Washington, USA
  13. 13 Department of Medicine-Cardiology, Policlinico San Donato, Milan, Italy
  14. 14 Department of Medicine-Nuclear Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
  1. Correspondence to Professor David L Prior, Department of Cardiology, St. Vincent’s Hospital, PO Box 2900, Fitzroy, Victoria 3065, Australia; david.prior{at}svha.org.au

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 analyse 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 (New York Heart Association) 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.

Trial registration number NCT00023595.

  • randomised clinical trial
  • coronary artery bypass grafting
  • ischaemic cardiomyopathy
  • surgical ventricular reconstruction
  • end-systolic volume index

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Footnotes

  • Funding This work was supported by Grants U01-HL69015, U01-HL69013 and R01-HL10583 from the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.

  • Competing interests DSB participates in royalties to Cedars-Sinai for the software used for some of the SPECT analysis.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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