Key result
Left ventricular function non-recovery after CABG was significantly associated with higher all-cause mortality compared to recovery (HR 2.14; 95% CI 1.60-2.86; P<0.001).
Why the study?
The incidence, determinants, and clinical impact of left ventricular function non-recovery after CABG in patients with ischaemic cardiomyopathy remained unclear.
Does left ventricular function recovery after CABG improve survival in patients with ischaemic cardiomyopathy?
Cohort (n=490)
No
Does left ventricular function recovery after CABG improve survival in patients with ischaemic cardiomyopathy?
Hazard Ratio: 2.14 (95% CI 1.6–2.86)
p-value: p=<0.001
Almost 40% of patients with ischaemic cardiomyopathy do not achieve LV function recovery after CABG, which is strongly associated with increased all-cause mortality.
LV non-recovery after CABG identifies high-risk patients; leaves open whether targeting predictors improves recovery and survival in ischaemic cardiomyopathy.
OBJECTIVES: This retrospective study aimed to clarify the incidence, determinants and clinical impact of left ventricular (LV) function non-recovery after coronary artery bypass grafting (CABG) in patients with ischaemic cardiomyopathy. METHODS: A total of 490 patients with ischaemic cardiomyopathy (LV ejection fraction ≤ 40%) undergoing CABG were analysed. Follow-up echocardiography was performed at 1 month, 1 year, and annually thereafter. LV function recovery was defined as ejection fraction (EF) ≥40% at least once during follow-up. LV function non-recovery was defined as EF <40% at any follow-up. The primary and secondary end points were changes in LV function and all-cause mortality, respectively. Clinical follow-up was completed in 461 patients (94.1%; mean follow-up: 64.5 ± 45.5 months). RESULTS: During follow-up, echocardiographic assessments were performed 1863 times (mean, 3.8 ± 2.4), and 193 patients (39.4%) exhibiting LV function non-recovery were identified. Overall survival was significantly higher in the recovery group (53.9%) than in the non-recovery group (31.4%) at 10 years (P < 0.001). Independent predictors of LV function non-recovery were preoperative LV end-systolic diameter [odds ratio (OR) 1.07, 95% confidence interval (CI) 1.04-1.10; P < 0.001] and bilateral internal thoracic artery grafting (OR 0.61, 95% CI 0.39-0.95; P = 0.028). In a multivariable Cox proportional hazards model, LV function non-recovery was significantly associated with all-cause mortality (hazard ratio 2.14, 95% CI 1.60-2.86; P < 0.001). CONCLUSIONS: Almost 40% of patients with ischaemic cardiomyopathy undergoing CABG did not achieve LV function recovery and were associated with poor prognosis. To achieve LV function recovery, CABG with bilateral internal thoracic artery may be recommended before excessive LV remodelling occurs. CLINICAL TRIAL REGISTRATION NUMBER: Institutional review board of Osaka University Hospital, number 16105.
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Nakae et al. (2021) conducted a cohort in ischaemic cardiomyopathy (n=490). Left ventricular function non-recovery vs. Left ventricular function recovery was evaluated on all-cause mortality (HR 2.14, 95% CI 1.60-2.86, p=<0.001). Left ventricular function non-recovery after CABG was significantly associated with higher all-cause mortality compared to recovery (HR 2.14; 95% CI 1.60-2.86; P<0.001).
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