Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, University Health Network, Toronto, Canada.
Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, University Health Network, Toronto, Canada.
Ann Thorac Surg. 2020 Sep;110(3):863-869. doi: 10.1016/j.athoracsur.2020.01.005. Epub 2020 Feb 16.
The interactive relationship between left ventricular (LV) ejection fraction (LVEF) and LV size in predicting perioperative outcomes after cardiac surgery has not been clarified.
This study reviewed all patients who underwent cardiac surgery between 2010 and 2016 with either preserved LVEF (>60%; n = 5685) or severely reduced LVEF (<20%; n = 143). LV size was categorized by using either LV end-diastolic or end-systolic diameter or a qualitative assessment, as follows: normal, smaller than 4 cm; mildly enlarged, 4.1 to 5.4 cm moderately enlarged, 5.5 to 6.5 cm; and severely enlarged, larger than 6.5 cm. Using propensity-score analysis, we matched patients with LVEF less than 20% (n = 143) in a 3:1 ratio with patients with LVEF greater than 60% (n = 429).
There were significant differences in mortality, major morbidity, and operative mortality and prolonged length of stay between patients with LVEF less than 20% and LVEF greater than 60%. In patients with LVEF less than 20%, there were no significant differences in outcomes between those with an LV size of 5.4 cm or smaller and an LV size of 5.5 cm or larger. In patients undergoing isolated coronary artery bypass grafting (CABG), LV size predicted mortality, major morbidity, and operative mortality (odds ratio, 5.5 [95% confidence interval, 2.0 to 15.7]; P < .001) and prolonged length of stay (odds ratio, 3.4 [95% confidence interval, 1.2 to 10.3]; P = .026), respectively.
LVEF is more important than LV size in predicting outcomes after cardiac surgery. However, in patients undergoing isolated CABG, LV size has an interactive effect with LVEF and can potentially aid the decision-making process. Risk adjustment models using only LVEF may be inaccurate, particularly with respect to isolated CABG procedures.
左心室射血分数（LVEF）与左心室大小之间的相互关系在心脏手术后预测围手术期结局方面尚未明确。
本研究回顾了 2010 年至 2016 年间接受心脏手术的所有患者，其中 LVEF 正常（>60%；n=5685）或严重降低（<20%；n=143）。使用左心室舒张末期或收缩末期直径或定性评估来对 LV 大小进行分类，如下所示：正常，小于 4 厘米；轻度增大，4.1 至 5.4 厘米；中度增大，5.5 至 6.5 厘米；严重增大，大于 6.5 厘米。通过倾向评分分析，我们将 LVEF<20%（n=143）的患者按 3:1 的比例与 LVEF>60%（n=429）的患者匹配。
LVEF<20%的患者与 LVEF>60%的患者在死亡率、主要发病率和手术死亡率以及住院时间延长方面存在显著差异。在 LVEF<20%的患者中，LV 大小为 5.4 厘米或更小与 LV 大小为 5.5 厘米或更大的患者之间的结局没有显著差异。在接受单纯冠状动脉旁路移植术（CABG）的患者中，LV 大小预测死亡率、主要发病率和手术死亡率（比值比，5.5 [95%置信区间，2.0 至 15.7]；P<0.001）和住院时间延长（比值比，3.4 [95%置信区间，1.2 至 10.3]；P=0.026）。
LVEF 比 LV 大小更能预测心脏手术后的结局。然而，在接受单纯 CABG 的患者中，LV 大小与 LVEF 具有交互作用，可能有助于决策过程。仅使用 LVEF 的风险调整模型可能不准确，特别是对于单纯 CABG 手术。
