Key result
High myocardial viability (≥10%) was associated with higher 36-month MACE-free survival compared to low myocardial viability (79.4% vs. 68.2%, P=0.004) in patients with ischemic HFrEF after CABG.
Why the study?
Data on the perioperative risk and long-term survival of patients with HFrEF caused by coronary heart disease after CABG are limited.
Does high myocardial viability improve long-term survival and reduce perioperative mortality in patients with ischemic HFrEF undergoing CABG?
Observational (n=118)
No
Does high myocardial viability improve long-term survival and reduce perioperative mortality in patients with ischemic HFrEF undergoing CABG?
Absolute Event Rate: 79.4% vs 68.2%
p-value: p=0.004
In patients with ischemic HFrEF undergoing CABG, high myocardial viability is associated with lower perioperative mortality and improved long-term MACE-free survival.
Viability assessment may stratify perioperative and long-term risk after CABG in ischemic HFrEF; leaves open its utility for guiding revascularization decisions.
Background: Heart failure with reduced ejection fraction (HFrEF) caused by coronary heart disease (CHD) accounts for the largest proportion of patients with heart failure and is associated with the poorest prognosis. However, date on the perioperative risk and long-term survival of patients with HFrEF are limited. The present study aimed at exploring the effects of the left ventricular end-systolic volume index (LVESVI) and myocardial viability on perioperative risk and long-term survival after coronary artery bypass grafting (CABG) in patients with HFrEF. Methods: This is a single center, prospective, observational study. CHD patients with symptoms and signs of heart failure and a left ventricular ejection fraction (LVEF) <40% were enrolled consecutively from January 2014 to February 2018. Operative mortality, perioperative complications and long-term survival were compared in the patients with various LVESVIs and myocardial viabilities. The primary outcomes were cardiac death, myocardial infarction, heart failure, stroke and revascularization [percutaneous coronary intervention (PCI) or redo CABG] with a median follow-up of 30±12 months. Results: Perioperative mortality was 6.8% in the 118 patients in this study. Perioperative mortality was significantly higher in the low myocardial viability (LMV) group than in the high myocardial viability (HMV) group (12.5% vs. 3.8%, P=0.034). The 12-, 24-, 36-month major adverse cardiac event (MACE)-free survival rate of patients with HMV was significantly higher than that of patients with LMV (HMV vs. LMV: 96.9% vs. 88.6%, 93.4% vs. 85.5%, 79.4% vs. 68.2%, P=0.004). There was no difference in MACE-free survival among patients with different degrees of left ventricular remodeling within each group. Conclusions: Myocardial viability is an important factor that affects the perioperative mortality and long-term survival of patients with ischemic HFrEF after CABG. Left ventricular remodeling increases perioperative mortality but has no effect on long-term survival.
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Cao et al. (2020) conducted an observational in Heart failure with reduced ejection fraction (HFrEF) caused by coronary heart disease (CHD) (n=118). High myocardial viability (≥10%) vs. Low myocardial viability (<10%) was evaluated on 36-month major adverse cardiac event (MACE)-free survival (p=0.004). High myocardial viability (≥10%) was associated with higher 36-month MACE-free survival compared to low myocardial viability (79.4% vs. 68.2%, P=0.004) in patients with ischemic HFrEF after CABG.
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