Improvement of left ventricular function with surgical revascularization in patients eligible for implantable cardioverter-defibrillator
© 2021 Wiley Periodicals LLC. This article has been contributed to by US Government employees and their work is in the public domain in the USA..
INTRODUCTION: Left ventricular ejection fraction (EF) ≤ 35% is the cornerstone criterion for implantable cardioverter-defibrillator (ICD) eligibility. Improvement in EF may occur in ICD-eligible patients after coronary artery bypass graft surgery (CABG). However, the incidence, predictors, and outcomes of this process are unclear.
METHODS AND RESULTS: We studied 427 patients with EF ≤ 35% who underwent CABG in the Surgical Treatment for Ischemic Heart Failure (STICH) trial and had a systematic pre- and postoperative (4 months) EF assessment using the identical cardiac imaging modality. All imaging studies were interpreted at a core laboratory. Improvement in EF was defined as postoperative EF > 35% and >5% absolute improvement from baseline. Of the 427 patients (mean age 61.8 ± 9.5 and 50 women), 125 (29.2%) had EF improvement. Their mean EF increased from 26.8% (±5.8%) to 43.3% (±6.5%) (p < .0001). EF improvement occurred in only 20% of patients with a preoperative EF < 25%. The odds of EF improvement were 1.96 times higher (95% confidence interval [CI]: 0.91-4.23, p = .09) in patients with myocardial viability. In adjusted analyses, EF improvement was associated with a significantly lower risk of all-cause mortality (hazard ratio [HR]: 0.58, 95% CI: 0.35-0.96; p = .03) and heart failure mortality (HR: 0.31, 95% CI: 0.11-0.87; p = .027).
CONCLUSION: Nearly 1/3rd of ICD-eligible patients undergoing CABG had significant improvement in EF, obviating the need for primary prevention ICD implantation. These results provide patients and clinicians data on the likelihood of ICD eligibility after CABG and support the practice of reassessment of EF after revascularization.
| Errataetall: |
CommentIn: J Cardiovasc Electrophysiol. 2022 Feb;33(2):252-253. - PMID 34904329 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:33 |
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| Enthalten in: |
Journal of cardiovascular electrophysiology - 33(2022), 2 vom: 12. Feb., Seite 244-251 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Adabag, Selçuk [VerfasserIn] |
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| Links: |
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| Themen: |
Coronary artery bypass surgery |
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| Anmerkungen: |
Date Completed 16.03.2022 Date Revised 31.05.2022 published: Print-Electronic CommentIn: J Cardiovasc Electrophysiol. 2022 Feb;33(2):252-253. - PMID 34904329 Citation Status MEDLINE |
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| doi: |
10.1111/jce.15315 |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM334343593 |
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| 500 | |a CommentIn: J Cardiovasc Electrophysiol. 2022 Feb;33(2):252-253. - PMID 34904329 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2021 Wiley Periodicals LLC. This article has been contributed to by US Government employees and their work is in the public domain in the USA. | ||
| 520 | |a INTRODUCTION: Left ventricular ejection fraction (EF) ≤ 35% is the cornerstone criterion for implantable cardioverter-defibrillator (ICD) eligibility. Improvement in EF may occur in ICD-eligible patients after coronary artery bypass graft surgery (CABG). However, the incidence, predictors, and outcomes of this process are unclear | ||
| 520 | |a METHODS AND RESULTS: We studied 427 patients with EF ≤ 35% who underwent CABG in the Surgical Treatment for Ischemic Heart Failure (STICH) trial and had a systematic pre- and postoperative (4 months) EF assessment using the identical cardiac imaging modality. All imaging studies were interpreted at a core laboratory. Improvement in EF was defined as postoperative EF > 35% and >5% absolute improvement from baseline. Of the 427 patients (mean age 61.8 ± 9.5 and 50 women), 125 (29.2%) had EF improvement. Their mean EF increased from 26.8% (±5.8%) to 43.3% (±6.5%) (p < .0001). EF improvement occurred in only 20% of patients with a preoperative EF < 25%. The odds of EF improvement were 1.96 times higher (95% confidence interval [CI]: 0.91-4.23, p = .09) in patients with myocardial viability. In adjusted analyses, EF improvement was associated with a significantly lower risk of all-cause mortality (hazard ratio [HR]: 0.58, 95% CI: 0.35-0.96; p = .03) and heart failure mortality (HR: 0.31, 95% CI: 0.11-0.87; p = .027) | ||
| 520 | |a CONCLUSION: Nearly 1/3rd of ICD-eligible patients undergoing CABG had significant improvement in EF, obviating the need for primary prevention ICD implantation. These results provide patients and clinicians data on the likelihood of ICD eligibility after CABG and support the practice of reassessment of EF after revascularization | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a coronary artery bypass surgery | |
| 650 | 4 | |a ejection fraction | |
| 650 | 4 | |a implantable cardioverter-defibrillator | |
| 650 | 4 | |a mortality | |
| 650 | 4 | |a predictors | |
| 650 | 4 | |a viability | |
| 700 | 1 | |a Carlson, Selma |e verfasserin |4 aut | |
| 700 | 1 | |a Gravely, Amy |e verfasserin |4 aut | |
| 700 | 1 | |a Buelt-Gebhardt, Melissa |e verfasserin |4 aut | |
| 700 | 1 | |a Madjid, Mohammad |e verfasserin |4 aut | |
| 700 | 1 | |a Naksuk, Niyada |e verfasserin |4 aut | |
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