Wang Shaoping, Lyu Yi, Cheng Shujuan, Zhang Yuchao, Gu Xiaoyan, Gong Ming, Liu Jinghua
Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China.
Department of Anesthesiology, Minhang Hospital, Fudan University, Shanghai, China.
Front Cardiovasc Med. 2022 Sep 29;9:967039. doi: 10.3389/fcvm.2022.967039. eCollection 2022.
To investigate the predictive roles of pre-operative left ventricular (LV) size and ejection fraction (EF) in EF improvement and outcome following revascularization in patients with coronary artery disease (CAD) and LV dysfunction.
Revascularization may improve EF and long-term outcomes of patients with LV dysfunction. However, the determinants of EF improvement have not yet been investigated comprehensively.
Patients with EF measurements before and 3 months after revascularization were enrolled in a cohort study (No. ChiCTR2100044378). All patients had baseline EF ≤ 40%. EF improvement was defined as absolute increase in EF > 5%. According to LV end-systolic diameter (LVESD) (severely enlarged or not) and EF (≤35% or of 36-40%) at baseline, patients were categorized into four groups.
A total of 939 patients were identified. A total of 549 (58.5%) had EF improved. Both LVESD [odds ratio (OR) per 1 mm decrease, 1.05; 95% CI, 1.04-1.07; < 0.001] and EF (OR per 1% decrease, 1.06; 95% CI, 1.03-1.10; < 0.001) at baseline were predictive of EF improvement after revascularization. Patients with LVESD not severely enlarged and EF ≤ 35% had higher odds of being in the EF improved group in comparison with other three groups both in unadjusted and adjusted analysis (all < 0.001). The median follow-up time was 3.5 years. Patients with LVESD not severely enlarged and EF ≤ 35% had significantly lower risk of all-cause death in comparison with patients with LVESD severely enlarged and EF ≤ 35% [hazard ratio (HR), 2.73; 95% CI, 1.28-5.82; = 0.009], and tended to have lower risk in comparison with patients with LVESD severely enlarged and EF of 36-40% (HR, 2.00; 95% CI, 0.93-4.27; = 0.074).
Among CAD patients with reduced EF (≤ 40%) who underwent revascularization, smaller pre-operative LVESD and lower EF had greatest potential to have EF improvement and better outcome. Our findings imply the indication for revascularization in patients with LV dysfunction who presented with lower EF but smaller LV size.
探讨术前左心室（LV）大小和射血分数（EF）对冠状动脉疾病（CAD）和LV功能障碍患者血运重建后EF改善及预后的预测作用。
血运重建可能改善LV功能障碍患者的EF和长期预后。然而，EF改善的决定因素尚未得到全面研究。
纳入一项队列研究（编号ChiCTR2100044378）中在血运重建前后均测量EF的患者。所有患者基线EF≤40%。EF改善定义为EF绝对增加>5%。根据基线时LV舒张末期内径（LVESD）（是否严重增大）和EF（≤35%或36 - 40%），将患者分为四组。
共纳入939例患者。其中549例（58.5%）EF得到改善。基线时LVESD每减少1mm的比值比（OR）为1.05；95%置信区间（CI）为1.04 - 1.07；P<0.001]和基线时EF每降低1%的OR为1.06；95%CI为1.03 - 1.10；P<0.001]均是血运重建后EF改善的预测因素。在未调整和调整分析中，LVESD未严重增大且EF≤35%的患者与其他三组相比，EF改善组的可能性更高（均P<0.001）。中位随访时间为3.5年。LVESD未严重增大且EF≤35%的患者与LVESD严重增大且EF≤35%的患者相比，全因死亡风险显著降低[风险比（HR）为2.73；95%CI为1.28 - 5.82；P = 0.009]，与LVESD严重增大且EF为36 - 40%的患者相比，死亡风险有降低趋势（HR为2.00；9%CI为0.93 - 4.27；P = 0.074）。
在接受血运重建的EF降低（≤40%）的CAD患者中，术前较小的LVESD和较低的EF具有最大的EF改善潜力和更好的预后。我们的研究结果提示，对于EF较低但LV大小较小的LV功能障碍患者，血运重建具有指征。
