Improvement of left ventricular function with surgical revascularization in patients eligible for implantable cardioverter-defibrillator.
J Cardiovasc Electrophysiol
; 33(2): 244-251, 2022 02.
Article
em En
| MEDLINE
| ID: mdl-34897883
ABSTRACT
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 ANDRESULTS:
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.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Desfibriladores Implantáveis
/
Disfunção Ventricular Esquerda
Tipo de estudo:
Etiology_studies
/
Prognostic_studies
Limite:
Aged
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Female
/
Humans
/
Middle aged
Idioma:
En
Revista:
J Cardiovasc Electrophysiol
Assunto da revista:
ANGIOLOGIA
/
CARDIOLOGIA
/
FISIOLOGIA
Ano de publicação:
2022
Tipo de documento:
Article
País de afiliação:
Estados Unidos