Prior David L, Stevens Susanna R, Holly Thomas A, Krejca Michal, Paraforos Alexandros, Pohost Gerald M, Byrd Krysti, Kukulski Tomasz, Jones Robert H, Desvigne-Nickens Patrice, Varadarajan Padmini, Amanullah Aman, Lin Grace, Al-Khalidi Hussein R, Aldea Gabriel, Santambrogio Carlo, Bochenek Andrzej, Berman Daniel S
Department of Medicine, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia.
Duke Clinical Research Institute (SRS,RHJ,HRA) and Department of Surgery Cardiothoracic (RHJ), Duke University School of Medicine, Durham, North Carolina, USA.
Heart. 2017 Sep;103(17):1359-1367. doi: 10.1136/heartjnl-2016-310693. Epub 2017 Apr 26.
To define the prognostic contribution of global and regional left ventricular (LV) function measurements in patients with ischaemic cardiomyopathy randomised to coronary artery bypass graft surgery (CABG) with (n=501) or without (n=499) surgical ventricular reconstruction (SVR).
Novel multivariable methods to analyse global and regional LV systolic function were used to better formulate prediction models for long-term mortality following CABG with or without SVR in the entire cohort of 1000 randomised SVR hypothesis patients. Key clinical variables were included in the analysis. Regional function was classified according to the discreteness of anteroapical hypokinesia and akinesia into those most likely to benefit from SVR, those least likely and those felt to have intermediate likelihood of benefit from SVR.
The most prognostic clinical variables identified in multivariable models include creatinine, LV end-systolic volume index (ESVI), age and NYHA (New York Heart Association) class. Addition of LV ejection fraction, LV end-diastolic volume index and regional function assessment did not contribute additional power to the model. Subgroup analysis based on regional function did not identify a cohort in which SVR improved mortality.
ESVI is the single parameter of LV function most predictive of mortality in patients with LV systolic dysfunction following CABG with or without SVR in multivariable models that include all key clinical and LV systolic function parameters. Assessment of regional cardiac function does not enhance prediction of mortality nor identify a subgroup for which SVR improves mortality. These results do not support elective addition of LV reconstruction surgery in patients undergoing CABG.
NCT00023595.
确定在随机接受冠状动脉搭桥术（CABG）且接受（n = 501）或未接受（n = 499）手术性心室重建（SVR）的缺血性心肌病患者中，整体和局部左心室（LV）功能测量对预后的影响。
采用新颖的多变量方法分析整体和局部LV收缩功能，以便在1000名随机接受SVR假设的患者的整个队列中，更好地构建接受或未接受SVR的CABG术后长期死亡率的预测模型。分析中纳入了关键临床变量。根据心尖前部运动减弱和运动消失的离散程度，将局部功能分为最可能从SVR中获益、最不可能获益以及被认为从SVR中获益可能性中等的情况。
多变量模型中确定的最具预后意义的临床变量包括肌酐、LV收缩末期容积指数（ESVI）、年龄和纽约心脏协会（NYHA）分级。添加LV射血分数、LV舒张末期容积指数和局部功能评估并未为模型增加额外的预测能力。基于局部功能的亚组分析未发现SVR能改善死亡率的队列。
在包含所有关键临床和LV收缩功能参数的多变量模型中，ESVI是LV收缩功能不全患者接受或未接受SVR的CABG术后死亡率最具预测性的LV功能单一参数。评估局部心脏功能并不能增强对死亡率的预测，也无法确定SVR能改善死亡率的亚组。这些结果不支持在接受CABG的患者中选择性地增加LV重建手术。
NCT00023595。
