Key result
Smaller pre-operative LVESD links to ~5% greater odds of post-revascularization EF improvement per millimeter decrease.
Why the study?
Revascularization may improve EF and long-term outcomes in patients with LV dysfunction, but the determinants of EF improvement have not been comprehensively investigated.
Do pre-operative left ventricular size and ejection fraction predict EF improvement and outcomes following revascularization in patients with CAD and LV dysfunction?
Cohort (n=939)
No
Do pre-operative left ventricular size and ejection fraction predict EF improvement and outcomes following revascularization in patients with CAD and LV dysfunction?
Effect estimate: OR 1.05 (95% CI 1.04-1.07)
p-value: p=<0.001
In patients with CAD and LV dysfunction undergoing revascularization, a smaller pre-operative LVESD and lower EF are associated with a greater likelihood of EF improvement and better long-term survival.
Smaller LVESD was associated with EF improvement after revascularization in CAD with reduced EF; hypothesis-generating and requires prospective validation before guiding selection.
Objectives 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. Background 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. Materials and methods 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. Results 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; P < 0.001] and EF (OR per 1% decrease, 1.06; 95% CI, 1.03–1.10; P < 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 P < 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; P = 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; P = 0.074). Conclusion 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.
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Wang et al. (2022) conducted a cohort in Coronary artery disease with left ventricular dysfunction (n=939). Revascularization (PCI or CABG) was evaluated on Ejection fraction improvement (absolute increase > 5%) (OR 1.05, 95% CI 1.04-1.07, p=<0.001). Among CAD patients with reduced EF undergoing revascularization, smaller pre-operative LVESD was associated with greater odds of EF improvement (OR 1.05 per 1 mm decrease).
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