Pouleur Anne-Catherine M, Rousseau Michel F, Ahn Sylvie A, Amzulescu Mihaela, Demeure Fabian, de Meester Christophe, Vancraeynest David, Pasquet Agnès, Vanoverschelde Jean-Louis, Gerber Bernhard L
Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Brussels, Belgium; Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium.
Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Brussels, Belgium; Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium.
Ann Thorac Surg. 2016 Jun;101(6):2176-84. doi: 10.1016/j.athoracsur.2015.11.035. Epub 2016 Feb 22.
Limited data are available regarding the prognostic value of right ventricular (RV) systolic dysfunction (RVSD) in patients with coronary artery disease. Our objective was to evaluate the effect of RVSD assessed by cardiac magnetic resonance on survival of patients with low left ventricular (LV) ejection fraction (EF) undergoing coronary bypass grafting (CABG).
We prospectively assessed overall and cardiovascular death of 107 consecutive patients (94 men; age, 66 ± 10 years) undergoing CABG who had a LVEF of 0.35 or less by cardiac magnetic resonance before CABG.
Mean LVEF was 0.25 ± 0.07, and mean RVEF was 0.46 ± 0.16. RVSD, defined by RVEF of 0.35 or less, was present in 32 patients (30%). In-hospital mortality rate (n = 8) was significantly higher in patients with RVSD (18.7% vs 2.7%, p = 0.004). Over a median follow-up of 4.7 years, 44 patients died, 33 of a cardiovascular cause. The primary end point of cardiovascular death was reached by 15 of 32 patients with RVSD and 18 of 75 patients without RVSD (47% vs 24%, p = 0.019). Univariate survival analysis showed that age, New York Heart Association Functional Classification, diabetes, estimated glomerular filtration rate, LVEF, LV indexed end-diastolic volume, RVEF, RV indexed end-diastolic volume, RV systolic function, and The Society of Thoracic Surgeons risk score were independent predictors of the primary end point of cardiovascular death. By multivariable analysis, the Society of Thoracic Surgeons risk score (hazard ratio, 1.32; 95% confidence interval, 1.13 to 1.55; p = 0.001) and RVSD (hazard ratio, 2.14; 95% confidence interval, 1.06 to 4.31; p = 0.034) remained significant independent predictors of cardiovascular death.
RVSD strongly and independently predicts cardiovascular death in patients with coronary artery disease and low EF undergoing CABG. Evaluation of RV function should thus be part of preoperative evaluation of such patients.
关于冠心病患者右心室（RV）收缩功能障碍（RVSD）的预后价值，现有数据有限。我们的目的是评估通过心脏磁共振评估的RVSD对接受冠状动脉旁路移植术（CABG）的低左心室（LV）射血分数（EF）患者生存率的影响。
我们前瞻性评估了107例连续接受CABG的患者（94例男性；年龄66±10岁）的全因死亡和心血管死亡情况，这些患者在CABG术前经心脏磁共振检查左心室射血分数为0.35或更低。
平均左心室射血分数为0.25±0.07，平均右心室射血分数为0.46±0.16。32例患者（30%）存在RVSD，定义为右心室射血分数为0.35或更低。RVSD患者的院内死亡率（n = 8）显著更高（18.7%对2.7%，p = 0.004）。在中位随访4.7年期间，44例患者死亡，其中33例死于心血管原因。32例RVSD患者中有15例、75例无RVSD患者中有18例达到心血管死亡的主要终点（47%对24%，p = 0.019）。单因素生存分析显示，年龄、纽约心脏协会功能分级、糖尿病、估计肾小球滤过率、左心室射血分数、左心室舒张末期容积指数、右心室射血分数、右心室舒张末期容积指数、右心室收缩功能以及胸外科医师协会风险评分是心血管死亡主要终点的独立预测因素。多变量分析显示，胸外科医师协会风险评分（风险比，1.32；95%置信区间，1.13至1.55；p = 0.001）和RVSD（风险比，2.14；95%置信区间，1.06至4.31；p = 0.034）仍然是心血管死亡的显著独立预测因素。
RVSD强烈且独立地预测接受CABG的冠心病低EF患者的心血管死亡。因此，对这类患者的术前评估应包括对右心室功能的评估。
