Key result
Lower preoperative left internal mammary artery flow velocity was an independent predictor of cardiac death within 18 months after CABG (HR 0.922), and combining it with mean graft flow and LVEF strongly predicted mortality.
Why the study?
The study was conducted to explore the value of ultrasound-measured preoperative left internal mammary artery flow velocity in predicting patient prognosis after left internal mammary artery bypass grafting.
Does preoperative left internal mammary artery flow velocity (LIMAV) combined with intraoperative mean graft flow (MGF) and LVEF improve the prediction of cardiac death in patients undergoing CABG?
Observational (n=104)
No
Does preoperative left internal mammary artery flow velocity (LIMAV) combined with intraoperative mean graft flow (MGF) and LVEF improve the prediction of cardiac death in patients undergoing CABG?
Hazard Ratio: 0.922 (95% CI 0.857–0.992)
p-value: p=0.029
Preoperative measurement of left internal mammary artery flow velocity by ultrasound, combined with intraoperative mean graft flow and LVEF, significantly improves the prediction of cardiac death after CABG.
Background: The purpose of this study was to explore the value of the left internal mammary artery flow velocity (LIMAV) measured by ultrasound before coronary artery bypass grafting (CABG) in predicting the prognosis of patients after left internal mammary artery (LIMA) bypass grafting. Methods: One hundred and four patients who underwent CABG with LIMA as the bridge vessel in the cardiovascular surgery department of our hospital between May 2018 and June 2019 were selected. All patients underwent transthoracic Doppler ultrasonography to measure LIMAV preoperatively. Intraoperatively, mean graft flow (MGF) and pulsatility index (PI) of the LIMA bridge were measured using transit time flow measurement (TTFM). The primary endpoint event in this study was cardiac death within 18 months after surgery. Results: The Cox survival analysis showed that the MGF, the LIMAV and left ventricular ejection fraction (LVEF) were risk factors for death after CABG. The cut-offs of MGF, LIMAV and LVEF for the prediction of death after CABG were ≤ 14 mL/min (area under the curve (AUC): 0.830; sensitivity: 100%; specificity: 65.6%), ≤ 60 cm/s (AUC: 0.759; sensitivity: 65.5%; specificity: 85.3%), and ≤ 44% (AUC: 0.724; sensitivity: 50%; specificity: 88.5%), respectively. Compared with the use of MGF, MGF + LIMAV, combination of the MGF + LIMAV + LVEF (AUC: 0.929; sensitivity: 100%; specificity: 81.1%) resulted in a stronger predictive value (MGF vs. MGF + LIMAV + LVEF: P = 0.02). Conclusion: LIMAV measured by preoperative transthoracic ultrasound combined with intraoperative MGF and LVEF may have a greater value in predicting patients' risk of cardiac death after CABG.
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Guo et al. (2023) conducted an observational in Coronary atherosclerotic heart disease (n=104). Preoperative left internal mammary artery flow velocity (LIMA V) was evaluated on Cardiac death within 18 months after surgery (HR 0.922, 95% CI 0.857-0.992, p=0.029). Lower preoperative left internal mammary artery flow velocity was an independent predictor of cardiac death within 18 months after CABG (HR 0.922), and combining it with mean graft flow and LVEF strongly predicted mortality.
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