Multiple factors analysis on the recovery of left ventricular ejection fraction in the revascularized patients with ischaemic cardiomyopathy
10.7507/1007-4848.201801065
- VernacularTitle:影响缺血性心肌病血运重建后左心室射血分数的多因素分析
- Author:
JIN Yan
1
;
WANG Huishan
1
;
JIANG Hui
1
;
TAO Dengshun
1
;
ZHAO Keyan
1
;
YU Yan
1
;
ZHAO Yang
Author Information
1. Department of Cardiovascular Surgery, Military General Hospital of Northern Theater Command General Hospital, Shenyang, 110016, P.R.China
- Publication Type:Journal Article
- Keywords:
Ischaemic cardiomyopathy;
coronary bypass grafting;
left ventricular ejection fraction;
left ventricular end-diastolic diameter
- From:
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
2018;25(12):1043-1048
- CountryChina
- Language:Chinese
-
Abstract:
Objective We probed how to predict left ventricular ejection fraction (LVEF) of the ischaemic cardiomyopathy (ICM) patients would be improved apparently after revascularization. Methods Between July 2010 and December 2015, 245 ICM patients (30%≤LVEF≤40%) with coronary bypass grafting (CABG) were retrospectively observed. Among them, 146 patients were accompanied by ischemic mitral regurgitation (IMR) (146/245, 59.6%), and 41 patients underwent mitral valvuloplasty or replacement because of more than moderate IMR. There were 13 patients early death, and other 232 patients who were followed up over 6 months were divided into two groups based on whether or not post-operative LVEF increased by 10%: a LVEF recovered group (group A, 124 patients) and a non-recovered group (group B, 108 patients). Results Preoperative NT-proBNP in the group A was significantly higher than that in the group B (P=0.036). There were less patients with myocardial infarction in the group A than that in the group B (P=0.047), and more with angina pectoris in the group A than that in the group B (P=0.024). There was no significant difference in the extent of mitral regurgitation or mitral surgery between the groups A and B (P>0.05). There were lower left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD) and left ventricular end-diastolic volume (LVEDV) in the group A than those in the group B (P<0.05). Multivariate analysis revealed that preoperative LVEDD dilated apparently and no angina pectoris existed before surgery were independent risk factors for LVEF with no recovery in the ICM patients (30%≤LVEF≤40%) after revascularization. The LVEDD of 245 patients (including 13 early deaths) was 41-71 mm. We found that the ICM patients with LVEDD ≥60 mm were more likely to signify the unfavourable prognosis (χ2=8.63, P=0.003, OR=2.21, 95% confidence interval 1.25 to 3.91). Conclusion Preoperative LVEDD dilated and no angina pectoris before surgery are independent risk factors for LVEF with no recovery in the ICM patients (30%≤LVEF≤40%) after revascularization. LVEDD≥60 mm can be regarded as the preoperative forecasting factors for the unfavourable prognosis in the ICM patients (30%≤LVEF≤40%) after revascularization.
