Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Republic of Korea.
Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
J Thorac Cardiovasc Surg. 2023 Jun;165(6):2063-2073.e2. doi: 10.1016/j.jtcvs.2021.06.026. Epub 2021 Jun 19.
Although coronary artery bypass grafting is expected to improve the outcomes of patients with advanced coronary artery disease, whether prognosis is different according to preoperative diastolic function remains unclear. This study sought to evaluate the prognostic implications of preoperative heart failure with preserved ejection fraction in patients undergoing coronary artery bypass grafting.
A total of 3593 consecutive patients with preserved ejection fraction (≥50%) who underwent coronary artery bypass grafting between January 1, 2001, and December 31, 2017, were evaluated. According to Heart Failure Association Pretest Assessment, Echocardiography and Natriuretic Peptide, Functional Testing, Final Etiology score, they were stratified into 3 groups: (1) non-heart failure with preserved ejection fraction (low-risk); (2) indeterminate (intermediate risk); and (3) heart failure with preserved ejection fraction (high risk). The primary outcome was all-cause death at 5 years after surgery.
Among the study population, 984 patients (27.4%) had preoperative heart failure with preserved ejection fraction. After coronary artery bypass grafting, 30-day survival in the heart failure with preserved ejection fraction group did not differ significantly from that in the non-heart failure with preserved ejection fraction group. The 5-year survival of the heart failure with preserved ejection fraction group was significantly lower than that of the non-heart failure with preserved ejection fraction group (91.9% vs 97.0%; adjusted hazard ratio, 2.41; 95% confidence interval, 1.29-4.50; P = .006). Follow-up echocardiography for the heart failure with preserved ejection fraction group showed no significant changes in early diastolic mitral annular velocity or left ventricular filling pressure compared with preoperative values.
On the basis of noninvasive assessment using Heart Failure Association Pretest Assessment, Echocardiography and Natriuretic Peptide, Functional Testing, Final Etiology score, a substantial proportion of patients with coronary artery disease who underwent coronary artery bypass grafting had preoperative heart failure with preserved ejection fraction. Preoperative heart failure with preserved ejection fraction was significantly associated with a decrease in the 5-year survival after successful coronary artery bypass grafting.
虽然冠状动脉旁路移植术有望改善晚期冠状动脉疾病患者的预后，但术前舒张功能是否不同仍不清楚。本研究旨在评估冠状动脉旁路移植术前射血分数保留的心衰对患者预后的影响。
本研究共纳入 2001 年 1 月 1 日至 2017 年 12 月 31 日期间接受冠状动脉旁路移植术且射血分数保留（≥50%）的连续 3593 例患者。根据心力衰竭协会术前评估、超声心动图和利钠肽、功能检测、最终病因评分，将患者分为 3 组：（1）非射血分数保留的心衰（低危）；（2）不确定（中危）；和（3）射血分数保留的心衰（高危）。主要终点是术后 5 年全因死亡。
在研究人群中，984 例患者（27.4%）术前有射血分数保留的心衰。冠状动脉旁路移植术后，射血分数保留的心衰组与非射血分数保留的心衰组的 30 天生存率无显著差异。射血分数保留的心衰组 5 年生存率明显低于非射血分数保留的心衰组（91.9%比 97.0%；调整后危险比，2.41；95%置信区间，1.29-4.50；P=0.006）。射血分数保留的心衰组的随访超声心动图显示，与术前相比，早期舒张期二尖瓣环速度或左心室充盈压无明显变化。
基于心力衰竭协会术前评估、超声心动图和利钠肽、功能检测、最终病因评分的无创评估，接受冠状动脉旁路移植术的冠状动脉疾病患者中，相当一部分患者术前存在射血分数保留的心衰。冠状动脉旁路移植术前射血分数保留的心衰与成功冠状动脉旁路移植术后 5 年生存率下降显著相关。
