Cardiac Ultrasound Laboratory, Division of Cardiology, Massachusetts General Hospital, Harvard University, Boston, MA 02114, USA.
Circulation. 2013 Jan 22;127(3):356-64. doi: 10.1161/CIRCULATIONAHA.112.127639. Epub 2012 Dec 12.
Although echocardiography is commonly performed before coronary artery bypass surgery, there has yet to be a study examining the incremental prognostic value of a complete echocardiogram.
Patients undergoing isolated coronary artery bypass surgery at 2 hospitals were divided into derivation and validation cohorts. A panel of quantitative echocardiographic parameters was measured. Clinical variables were extracted from the Society of Thoracic Surgeons database. The primary outcome was in-hospital mortality or major morbidity, and the secondary outcome was long-term all-cause mortality. The derivation cohort consisted of 667 patients with a mean age of 67.2±11.1 years and 22.8% females. The following echocardiographic parameters were found to be optimal predictors of mortality or major morbidity: severe diastolic dysfunction, as evidenced by restrictive filling (odds ratio, 2.96; 95% confidence interval, 1.59-5.49), right ventricular dysfunction, as evidenced by fractional area change <35% (odds ratio, 3.03; 95% confidence interval, 1.28-7.20), or myocardial performance index >0.40 (odds ratio, 1.89; 95% confidence interval, 1.13-3.15). These results were confirmed in the validation cohort of 187 patients. When added to the Society of Thoracic Surgeons risk score, the echocardiographic parameters resulted in a net improvement in model discrimination and reclassification with a change in c-statistic from 0.68 to 0.73 and an integrated discrimination improvement of 5.9% (95% confidence interval, 2.8%-8.9%). In the Cox proportional hazards model, right ventricular dysfunction and pulmonary hypertension were independently predictive of mortality over 3.2 years of follow-up.
Preoperative echocardiography, in particular right ventricular dysfunction and restrictive left ventricular filling, provides incremental prognostic value in identifying patients at higher risk of mortality or major morbidity after coronary artery bypass surgery.
尽管超声心动图在冠状动脉旁路移植术前通常会进行，但目前仍缺乏一项研究来检查完整超声心动图的增量预后价值。
在 2 家医院接受单纯冠状动脉旁路移植术的患者被分为推导队列和验证队列。测量了一系列定量超声心动图参数。从胸外科医师协会数据库中提取临床变量。主要终点是院内死亡率或主要发病率，次要终点是长期全因死亡率。推导队列由 667 例平均年龄为 67.2±11.1 岁、22.8%为女性的患者组成。以下超声心动图参数被发现是死亡率或主要发病率的最佳预测指标：严重舒张功能障碍，表现为限制性充盈（优势比，2.96；95%置信区间，1.59-5.49），右心室功能障碍，表现为节段性面积变化<35%（优势比，3.03；95%置信区间，1.28-7.20），或心肌做功指数>0.40（优势比，1.89；95%置信区间，1.13-3.15）。这些结果在验证队列的 187 例患者中得到了证实。当加入胸外科医师协会风险评分时，超声心动图参数导致模型区分度和重新分类的净改善，C 统计量从 0.68 增加到 0.73，综合判别改善为 5.9%（95%置信区间，2.8%-8.9%）。在 Cox 比例风险模型中，右心室功能障碍和肺动脉高压是 3.2 年随访期间死亡率的独立预测因素。
术前超声心动图，特别是右心室功能障碍和限制性左心室充盈，提供了增量预后价值，可识别出冠状动脉旁路移植术后死亡率或主要发病率较高的患者。
