Yan Pengyun, Zhang Kui, Cao Jian, Dong Ran
Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China.
Int J Gen Med. 2022 Jan 4;15:53-62. doi: 10.2147/IJGM.S341145. eCollection 2022.
The relationship between abnormal left ventricular (LV) structure and adverse outcomes has been confirmed in diverse patient groups in previous studies. However, it remains uncertain whether LV structure has predictive implications in heart failure with reduced ejection fraction (HFrEF) patients with coronary artery bypass grafting (CABG).
This study retrospectively enrolled patients who had HFrEF and underwent CABG between January 2013 and July 2019. According to LV hypertrophy (LVH) and LV enlargement (LVE) assessed by echocardiography, patients were classified into four LV structure types: (-)LVH/(-)LVE, (+)LVH/(-)LVE, (-)LVH/(+)LVE, and (+)LVH/(+)LVE.
A total of 435 consecutive patients (mean age: 59.4 ± 9.6 years; 14.9% female) were enrolled in the present study. Examined independently, either LVH (p < 0.001) or LVE (p < 0.001) was independently associated with postoperative mortality in multivariate analysis. When LVH and LVE were analyzed in combination, the risk of mortality after CABG was lowest in (-)LVH/(-)LVE and increased with (+)LVH/(-)LVE (odds ratio [OR]: 7.525; 95% confidence interval [CI]: 1.827-30.679, p = 0.004), (-)LVH/(+)LVE (OR: 7.253; 95% CI: 1.950-27.185, p = 0.003), and (+)LVH/(+)LVE (OR: 9.547; 95% CI: 2.726-34.805, p < 0.001), independent of other risk factors. Adding LV structural types to the baseline model gained an incremental effect on the predictive value for postoperative mortality (AUC: baseline model, 0.838 vs baseline model + LV structural types, 0.901, p for comparison = 0.010; category-free net reclassification improvement (NRI): 0.764, p < 0.001; integrated discrimination improvement (IDI): 0.061, p = 0.007).
LVH and LVE were associated with an increased risk of postoperative mortality after CABG in patients with HFrEF. Categorizing LV structural patterns with LVH and LVE contributes to risk stratification and provides incremental predictive ability. Routine echocardiographic assessment of LVH and LVE is needed in clinical practice.
既往研究已在不同患者群体中证实左心室（LV）结构异常与不良结局之间的关系。然而，对于冠状动脉旁路移植术（CABG）的射血分数降低的心力衰竭（HFrEF）患者，LV结构是否具有预测意义仍不确定。
本研究回顾性纳入了2013年1月至2019年7月期间患有HFrEF并接受CABG的患者。根据超声心动图评估的LV肥厚（LVH）和LV扩大（LVE），将患者分为四种LV结构类型：（-）LVH/（-）LVE、（+）LVH/（-）LVE、（-）LVH/（+）LVE和（+）LVH/（+）LVE。
本研究共纳入435例连续患者（平均年龄：59.4±9.6岁；女性占14.9%）。多因素分析显示，单独检查时，LVH（p<0.001）或LVE（p<0.001）均与术后死亡率独立相关。当联合分析LVH和LVE时，CABG术后死亡风险在（-）LVH/（-）LVE组最低，并随着（+）LVH/（-）LVE（优势比[OR]：7.525；95%置信区间[CI]：1.827 - 30.679，p = 0.004）、（-）LVH/（+）LVE（OR：7.253；95%CI：1.950 - 27.185，p = 0.003）和（+）LVH/（+）LVE（OR：9.547；95%CI：2.726 - 34.805，p<0.001）升高，且独立于其他风险因素。在基线模型中加入LV结构类型对术后死亡率的预测价值有增量影响（曲线下面积：基线模型为0.838，基线模型+LV结构类型为0.901，比较p = 0.010；无类别净重新分类改善[NRI]：0.764，p<0.001；综合判别改善[IDI]：0.061，p = 0.007）。
在HFrEF患者中，LVH和LVE与CABG术后死亡风险增加相关。用LVH和LVE对LV结构模式进行分类有助于风险分层并提供增量预测能力。临床实践中需要对LVH和LVE进行常规超声心动图评估。
