The evaluation of preoperative right ventricular diastolic dysfunction on coronary artery disease patients with left ventricular dysfunction.

OBJECTIVE

Early death following coronary artery bypass graft (CABG) surgery tends to occur in coronary heart disease (CHD) patients with significantly decreased left ventricular function.

METHODS

The clinical data of 231 patients with preoperative left ventricular ejection fraction (LVEF) ≤ 35% who underwent CABG were retrospectively analyzed from June 2007 to October 2012. The patients were divided into 2 groups: group A contained 39 patients who suffered early postoperative death and group B contained 192 patients who had a successful CABG outcome.

RESULTS

Multivariate analysis demonstrated that only significantly decreased preoperative right ventricular (RV) diastolic function (increase in Et/Et') and lack of suitable target bypass vessels were independent risk factors for early death after CABG surgery in patients with severely impaired left ventricular function (P = 0.003 and 0.002, respectively). Other factors, including age, intra-aortic balloon pump (IABP) implantation, ischemic mitral regurgitation (IMR) treatment, left atrial internal diameter, and end-diastolic left ventricular internal diameter, were not associated with early death following CABG. Preoperative Et/Et' ≥ 10 was significantly associated with early death after CABG in patients with severely impaired left ventricular function (χ(2) = 11.55, P < 0.001, odds ratio [OR] = 17.54, 95% confidence interval [CI]: 2.12-383.16).

CONCLUSION

Decreased preoperative RV diastolic function and lack of suitable target bypass vessels are independent risk factors for early death following CABG in patients with severely impaired left ventricular function. Therefore, assessment of preoperative RV diastolic function will be helpful in predicting early death after CABG in these patients. Additionally, Et/Et' ≥ 10 is significantly associated with early death after CABG.