Abstract
Introduction: The ratio of early mitral inflow velocity to early diastolic strain rate (E/e’sr) is a novel echocardiographic measure to estimate early left ventricular (LV) filling pressure. Hypothesis: We hypothesize that E/e’sr is a predictor of outcome following coronary artery bypass grafting (CABG) and that it is superior to the conventionally used E/e’. Methods: Consecutive patients undergoing isolated CABG at Gentofte Hospital (n=652) were included. Prior to surgery, all patients underwent an extensive echocardiographic examination. The outcome was all-cause mortality. Cox proportional hazard regression models were used to assess the prognostic value of E/e’sr in relation to the outcome. Results: The mean age of the study population was 67±9 years, 84% were male, mean LV ejection fraction was 50±11%. During follow-up (median 3.8 years [IQR: 2.7; 4.9 years]), a total of 73 (11%) died. Both E/e’ and E/e’sr were significant predictors in univariable models. In a multivariable model adjusted for demographic, clinical and echocardiographic covariates, E/e’sr remained an independent predictor of outcome (HR:1.05 [1.01-1.10], p=0.049, per 10cm increase) whereas E/e’ did not (HR:1.05 [0.99-1.11], p=0.053, per 1-unit increase). The relationship between E/e’sr, and the outcome was significantly modified by GLS (p for interaction = 0.043) ( Figure ). In the multivariable model, E/e’sr was still significantly associated with the outcome in patients with high GLS (≥13.6%) (HR:1.18 [1.02-1.36], p=0.029) but not in patients with low GLS (HR 1.04 CI95%: [0.99-1.10], p=0.14). E/e’ was not a significant predictor of all-cause mortality after multivariable adjustment in neither of the groups. E/e’sr improved net reclassification with 0.33 when added to the EuroSCOREII model. Conclusions: Following CABG, preoperative E/e’sr is an independent predictor of all-cause mortality, especially in patients with preserved systolic function and superior to E/e’.
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