Lella Leela K, Sales Virna L, Goldsmith Yulia, Chan Jacqueline, Iskandir Marina, Gulkarov Iosif, Tortolani Anthony, Brener Sorin J, Sacchi Terrence J, Heitner John F
Division of Cardiology, New York Methodist Hospital, Brooklyn, NY, 11215, United States of America.
Department of Cardiothoracic Surgery, New York Methodist Hospital, Brooklyn, NY, 11215, United States of America.
PLoS One. 2015 Jul 21;10(7):e0132808. doi: 10.1371/journal.pone.0132808. eCollection 2015.
The significance of right ventricular ejection fraction (RVEF), independent of left ventricular ejection fraction (LVEF), following isolated coronary artery bypass grafting (CABG) and valve procedures remains unknown. The aim of this study is to examine the significance of abnormal RVEF by cardiac magnetic resonance (CMR), independent of LVEF in predicting outcomes of patients undergoing isolated CABG and valve surgery.
From 2007 to 2009, 109 consecutive patients (mean age, 66 years; 38% female) were referred for pre-operative CMR. Abnormal RVEF and LVEF were considered <35% and <45%, respectively. Elective primary procedures include CABG (56%) and valve (44%). Thirty-day outcomes were perioperative complications, length of stay, cardiac re-hospitalizations and early mortaility; long-term (> 30 days) outcomes included, cardiac re-hospitalization, worsening congestive heart failure and mortality. Mean clinical follow up was 14 months.
Forty-eight patients had reduced RVEF (mean 25%) and 61 patients had normal RVEF (mean 50%) (p<0.001). Fifty-four patients had reduced LVEF (mean 30%) and 55 patients had normal LVEF (mean 59%) (p<0.001). Patients with reduced RVEF had a higher incidence of long-term cardiac re-hospitalization vs. patients with normal RVEF (31% vs.13%, p<0.05). Abnormal RVEF was a predictor for long-term cardiac re-hospitalization (HR 3.01 [CI 1.5-7.9], p<0.03). Reduced LVEF did not influence long-term cardiac re-hospitalization.
Abnormal RVEF is a stronger predictor for long-term cardiac re-hospitalization than abnormal LVEF in patients undergoing isolated CABG and valve procedures.
在单纯冠状动脉旁路移植术（CABG）和瓣膜手术之后，独立于左心室射血分数（LVEF）的右心室射血分数（RVEF）的意义仍不明确。本研究的目的是通过心脏磁共振成像（CMR）检查异常RVEF的意义，该异常RVEF独立于LVEF，用于预测接受单纯CABG和瓣膜手术患者的预后。
2007年至2009年，连续109例患者（平均年龄66岁；38%为女性）接受术前CMR检查。RVEF和LVEF异常分别定义为<35%和<45%。择期一期手术包括CABG（56%）和瓣膜手术（44%）。30天预后指标为围手术期并发症、住院时间、心脏再入院率和早期死亡率；长期（>30天）预后指标包括心脏再入院、充血性心力衰竭恶化和死亡率。平均临床随访时间为14个月。
48例患者RVEF降低（平均25%），61例患者RVEF正常（平均50%）（p<0.001）。54例患者LVEF降低（平均30%），55例患者LVEF正常（平均59%）（p<0.001）。与RVEF正常的患者相比，RVEF降低的患者长期心脏再入院率更高（31%对13%，p<0.05）。异常RVEF是长期心脏再入院的预测指标（HR 3.01[CI 1.5 - 7.9]，p<0.03）。LVEF降低不影响长期心脏再入院。
在接受单纯CABG和瓣膜手术的患者中，异常RVEF比异常LVEF更能预测长期心脏再入院。
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