Adabag Selçuk, Carlson Selma, Gravely Amy, Buelt-Gebhardt Melissa, Madjid Mohammad, Naksuk Niyada
Division of Cardiology, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA.
Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
J Cardiovasc Electrophysiol. 2022 Feb;33(2):244-251. doi: 10.1111/jce.15315. Epub 2021 Dec 21.
Left ventricular ejection fraction (EF) ≤ 35% is the cornerstone criterion for implantable cardioverter-defibrillator (ICD) eligibility. Improvement in EF may occur in ICD-eligible patients after coronary artery bypass graft surgery (CABG). However, the incidence, predictors, and outcomes of this process are unclear.
We studied 427 patients with EF ≤ 35% who underwent CABG in the Surgical Treatment for Ischemic Heart Failure (STICH) trial and had a systematic pre- and postoperative (4 months) EF assessment using the identical cardiac imaging modality. All imaging studies were interpreted at a core laboratory. Improvement in EF was defined as postoperative EF > 35% and >5% absolute improvement from baseline. Of the 427 patients (mean age 61.8 ± 9.5 and 50 women), 125 (29.2%) had EF improvement. Their mean EF increased from 26.8% (±5.8%) to 43.3% (±6.5%) (p < .0001). EF improvement occurred in only 20% of patients with a preoperative EF < 25%. The odds of EF improvement were 1.96 times higher (95% confidence interval [CI]: 0.91-4.23, p = .09) in patients with myocardial viability. In adjusted analyses, EF improvement was associated with a significantly lower risk of all-cause mortality (hazard ratio [HR]: 0.58, 95% CI: 0.35-0.96; p = .03) and heart failure mortality (HR: 0.31, 95% CI: 0.11-0.87; p = .027).
Nearly 1/3rd of ICD-eligible patients undergoing CABG had significant improvement in EF, obviating the need for primary prevention ICD implantation. These results provide patients and clinicians data on the likelihood of ICD eligibility after CABG and support the practice of reassessment of EF after revascularization.
左心室射血分数（EF）≤35%是植入式心脏复律除颤器（ICD）适用的关键标准。符合ICD植入标准的患者在冠状动脉旁路移植术（CABG）后EF可能会有所改善。然而，这一过程的发生率、预测因素及结果尚不清楚。
我们研究了427例EF≤35%且在缺血性心力衰竭外科治疗（STICH）试验中接受CABG的患者，这些患者术前和术后（4个月）使用相同的心脏成像方式进行了系统的EF评估。所有影像学研究均在核心实验室进行解读。EF改善定义为术后EF>35%且较基线绝对改善>5%。在这427例患者（平均年龄61.8±9.5岁，女性50例）中，125例（29.2%）EF得到改善。他们的平均EF从26.8%（±5.8%）增至43.3%（±6.5%）（p<0.0001）。术前EF<25%的患者中只有20%出现EF改善。心肌存活的患者EF改善几率高1.96倍（95%置信区间[CI]：0.91 - 4.23，p = 0.09）。在多因素分析中，EF改善与全因死亡率显著降低（风险比[HR]：0.58，95%CI：0.35 - 0.96；p = 0.03）及心力衰竭死亡率降低（HR：0.31，95%CI：0.11 - 0.87；p = 0.027）相关。
近三分之一符合ICD植入标准且接受CABG的患者EF有显著改善，无需进行一级预防ICD植入。这些结果为患者和临床医生提供了CABG后ICD适用可能性的数据，并支持血运重建后重新评估EF的做法。
