Key result
Preoperative E/e'sr outperforms conventional E/e', predicting ~5% higher CABG mortality risk per 10 cm increase.
Why the study?
It was hypothesized that E/e'sr, a novel echocardiographic measure to estimate early LV filling pressure, predicts outcome after CABG and is superior to conventional E/e'.
Does preoperative E/e'sr predict all-cause mortality better than conventional E/e' in patients undergoing isolated CABG?
Cohort (n=652)
No
Does preoperative E/e'sr predict all-cause mortality better than conventional E/e' in patients undergoing isolated CABG?
Hazard Ratio: 1.05 (95% CI 1.01–1.1)
p-value: p=0.049
Preoperative E/e'sr is an independent predictor of long-term all-cause mortality following CABG, superior to conventional E/e', especially in patients with preserved systolic function.
E/e'sr was associated with post-CABG mortality and reclassified risk beyond EuroSCORE II; leaves open whether it should supplant E/e' in routine assessment.
BACKGROUND: The ratio of early mitral inflow velocity to early diastolic strain rate (E/e'sr) is a novel echocardiographic measure to estimate early left ventricular (LV) filling pressure. We hypothesize that E/e'sr is a predictor of outcome following coronary artery bypass grafting (CABG) and that it is superior to the conventionally used E/e'. METHODS & RESULTS: Consecutive patients undergoing isolated CABG at Gentofte Hospital (n = 652) were included. The mean age of the study population was 67 ± 9 years, 84% were male, mean LVEF was 50 ± 11%. Prior to surgery, all patients underwent an extensive echocardiographic examination. The outcome was all-cause mortality. During follow-up (median 3.8 years [IQR: 2.7; 4.9 years]), a total of 73 (11.2%) died. Both E/e' and E/e'sr were significant predictors in univariable models. In a multivariable model, E/e'sr remained an independent predictor of outcome (HR:1.05 [1.01-1.10], p = 0.049, per 10 cm increase) whereas E/e' did not (HR:1.05 [0.99-1.11], p = 0.053, per 1-unit increase). The relationship between E/e'sr, and the outcome was significantly modified by GLS (p for interaction = 0.043). In the multivariable model, E/e'sr was still significantly associated with the outcome in patients with high GLS (≥13.6%) (HR:1.18 [1.02-1.36], p = 0.029) but not in patients with low GLS (HR 1.04 CI95%: [0.99-1.10], p = 0.14). E/e' was not a significant predictor of all-cause mortality after multivariable adjustment in neither of the groups. E/e'sr improved net reclassification with 33% when added to EuroSCOREII. CONCLUSION: Following CABG, preoperative E/e'sr is an independent predictor of all-cause mortality, especially in patients with preserved systolic function and superior to E/e'.
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Lassen et al. (2021) conducted a cohort in Isolated coronary artery bypass grafting (CABG) (n=652). Preoperative E/e'sr (ratio of early mitral inflow velocity to early diastolic strain rate) vs. Conventional E/e' was evaluated on All-cause mortality (HR 1.05, 95% CI 1.01-1.10, p=0.049). Preoperative E/e'sr was an independent predictor of all-cause mortality following CABG (HR 1.05; 95% CI 1.01-1.10; p=0.049 per 10 cm increase), and was superior to conventional E/e'.
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