Key result
Prolonged total isovolumic time prior to CABG independently predicted post-operative cardiac events or death (OR 1.37; 95% CI 1.02-1.84; P=0.035).
Why the study?
Does prolonged total isovolumic time predict hospital admission for a cardiac event or death in patients undergoing routine CABG?
Cohort (n=74)
Does prolonged total isovolumic time predict hospital admission for a cardiac event or death in patients undergoing routine CABG?
Odds Ratio: 1.37 (95% CI 1.02–1.84)
p-value: p=0.035
Prolonged total isovolumic time assessed by pre-CABG echocardiography is an independent predictor of adverse cardiac events following surgery, suggesting a role for identifying persistent ventricular dyssynchrony.
Prolonged total isovolumic time was associated with post-CABG events; leaves open its incremental value for preoperative risk stratification.
AIMS: Left ventricular (LV) systolic dysfunction may be associated with compromised stroke volume, which may be caused by asynchrony, reflected on the prolongation of isovolumic time (t-IVT). To assess the prognostic role of Doppler echocardiographic measurements in predicting cardiac events after coronary artery bypass grafting (CABG). METHODS AND RESULTS: The study included 74 patients undergoing routine CABG. A pre-CABG Doppler echocardiographic assessment of LV dimensions, filling and ejection was performed and t-IVT was determined as [60 - (total ejection time + total filling time)]. Follow-up period was 18 +/- 12 months. Of the 74 patients (age 65 +/- 16 years, 59 males), 29 underwent hospital admission for a cardiac event or died. There were no differences in age, gender, incidence of previous infarct or mitral regurgitation, LV-EDD (left ventricular end-diastolic dimension), left atrial or right ventricular size in patients with cardiac events compared with those without events. Left ventricular end-systolic dimension (LV-ESD) was greater (4.5 +/- 0.9 vs. 3.9 +/- 0.9 cm, P = 0.003), fractional shortening (FS) was lower (21 +/- 4 vs. 32 +/- 8%), E:A ratio and Tei index were higher (2.1 +/- 0.8 vs. 1.0 +/- 0.6 and 0.9 +/- 0.3 vs. 0.6 +/- 0.3, all P < 0.001), and t-IVT was longer (16 +/- 5 vs.10 +/- 4 s/min, P < 0.001) in patients with events. Multivariate predictors of post-CABG events (odds ratio 95% confidence interval) were low FS [0.66 (0.50-0.87), P < 0.001], high E:A ratio [l4.13 (1.17-14.60), P = 0.028], large LV-ESD [0.19 (0.05-0.84), P = 0.029], and long t-IVT [1.37 (1.02-1.84), P = 0.035]. CONCLUSION: Despite satisfactory surgical revascularization, long t-IVT and systolic dysfunction suggest persistent ventricular dyssynchrony that contributes to post-CABG cardiac events. Early assessment of such patients for potential benefit from electrical resynchronization may optimize their cardiac performance and hence clinical outcome.
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Bajraktari et al. (2008) conducted a cohort in Coronary artery disease requiring CABG (n=74). Prolonged total isovolumic time (t-IVT) vs. Normal/shorter t-IVT was evaluated on Hospital admission for a cardiac event or death (OR 1.37, 95% CI 1.02-1.84, p=0.035). Prolonged total isovolumic time prior to CABG independently predicted post-operative cardiac events or death (OR 1.37; 95% CI 1.02-1.84; P=0.035).
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