Abstract
BackgroundPrevious studies have shown that viable myocardium predicts recovery of left ventricular (LV) dysfunction after revascularization. Our aim was to evaluate the prognostic value of myocardial scar assessed by late gadolinium-enhanced cardiovascular magnetic resonance imaging (LGE-CMR) on functional recovery in patients undergoing coronary artery bypass grafting (CABG).MethodsFrom November 2009 to September 2012, 63 patients with reduced left ventricular ejection fraction (LVEF) referred for first-time isolated CABG were prospectively enrolled, 52 were included in final analysis. LV functional parameters and scar tissue were assessed by LGE-CMR at baseline and 6 months after surgery. Patency of grafts was evaluated by computed tomography angiography (CTA) 6 months post-CABG. Predictors for global functional recovery were analyzed.ResultsThe baseline LVEF was 32.7±9.2%, which improved to 41.6±11.0% 6 months later and 32/52 patients improved LVEF by ≥5%. Multivariate logistic regression analysis showed that the most significant negative predictor for global functional recovery was the number of scar segments (Odds ratio 2.864, 95% Confidence Interval 1.172–6.996, p = 0.021). Receiver-Operator-Characteristic (ROC) analysis demonstrated that ≤4 scar segments predicted global functional recovery with a sensitivity and specificity of 85.0% and 87.5%, respectively (AUC = 0.91, p<0.001). Comparison of ROC curves also indicated that scar tissue was superior to viable myocardium in predicting cardiac functional recovery (p<0.001).ConclusionsOur findings indicated that scar tissue on LGE-CMR is an independent negative predictor of cardiac functional recovery in patients with impaired LV function undergoing CABG. These observations may be helpful for clinicians and cardiovascular surgeons to determine which patients are most likely to benefit from surgical revascularization.
Highlights
Coronary artery bypass grafting (CABG) has been shown to improve both symptoms and prognosis in patients with coronary artery disease (CAD) and left ventricular (LV) dysfunction
The major aim of the current study is to help cardiovascular surgeons identify which patients with depressed left ventricular ejection fraction (LVEF) are most likely to benefit from surgical revascularization, the segmentation of the CMR-data might be easier for them to
We conclude that scar tissue on LGECMR is an independent negative predictor of cardiac functional recovery in patients with LV dysfunction undergoing surgical revascularization
Summary
Coronary artery bypass grafting (CABG) has been shown to improve both symptoms and prognosis in patients with coronary artery disease (CAD) and left ventricular (LV) dysfunction. Previous studies have linked improvement in cardiac function or survival after CABG to the presence of dysfunctional but viable myocardium [2,3,4,5]. Other studies indicated that to include only viable myocardium in a studying algorithm has limitations in predicting global functional improvement and not all patients with ischemic cardiomyopathy recover in function after successful revascularization, despite the presence of viable myocardium identified using various imaging protocols [7,8]. Previous studies have shown that viable myocardium predicts recovery of left ventricular (LV) dysfunction after revascularization. Our aim was to evaluate the prognostic value of myocardial scar assessed by late gadoliniumenhanced cardiovascular magnetic resonance imaging (LGE-CMR) on functional recovery in patients undergoing coronary artery bypass grafting (CABG)
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