Coronary Artery Bypass Grafting Portends Decreased Right Ventricucular Function (original) (raw)
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BMC Cardiovascular Disorders
Background: Coronary artery bypass graft (CABG) surgery is an effective therapeutic strategy for coronary heart disease (CHD). Myocardial longitudinal strain echocardiography with 2D speckle tracking could obtain ventricular function with better accuracy and reliability than the left ventricular ejection fraction. The aim of the study was to assess changes in left ventricular function in patients before and after surgical revascularization for a 24-month period of observation, using echocardiography with speckle tracking strain imaging. We searched for echocardiographic predictors of poor early and long-term outcome after CABG. Methods: We enrolled 69 patients scheduled for elective coronary bypass grafting. Patients were divided into groups based on pre-operative systolic and diastolic parameters, depending on the GLS value and the E' Lat and E/E' value. The correlation between these parameters and early and long-term outcomes was analyzed. Results: Preoperative EF was preserved in 86, 95% (60) patients. Pre-operative reduced GLS was observed in 73.91% (51) of patients and severely reduced in 31.88% (22). In the first post-operative 6-month period, we observed a significant decrease in the GLS. The GLS was a predictor of early postoperative outcome for intubation time, the inotropes use and length of ICU stay. Diastolic dysfunction was a predictor of the greater inotrope requirements. Conclusions: Global longitudinal strain and diastolic dysfunction parameters are a good predictors of worse early outcome after CABG.
ARYA Atherosclerosis, 2019
BACKGROUND Coronary artery bypass grafting (CABG) surgery is widely accepted as a revascularization method for coronary artery disease (CAD). Despite survival benefit and improvement in quality of life, CABG may impose major morbidities and significant complications. Right ventricle (RV) dysfunction is an important complication that may affect patient's longevity and functional capacity. The aim of this study was to evaluate the relationship between RV dysfunction and some invisible parameters like inferior vena cava (IVC) size with physical capacity. METHODS In this prospective study, 61 eligible CABG candidates were enrolled and RV function was assessed by echocardiographic parameters before CABG and one week and six months after the procedure, using tricuspid annular plane systolic excursion (TAPSE), Tei Index (TI), peak systolic movement (Sm) (cm/s), and IVC size. Functional capacity was assessed by six-minute walk test (6-MWT) 6 months after CABG. RESULTS 58 patients who di...
Changes in Right Ventricular Function After Off-Pump Coronary Artery Bypass Grafting
Journal of Cardiothoracic and Vascular Anesthesia, 2020
Objective: Right ventricular (RV) dysfunction is associated with poor outcomes after cardiac surgery. The aim of this study was to assess RV systolic and diastolic function in the perioperative period after off-pump coronary artery bypass grafting (OPCAB). Design: Prospective observational study. Settings: Tertiary care hospital. Participants: Thirty adult patients undergoing OPCAB. Interventions: None. Measurements and Main Results: Transthoracic echocardiography was performed twice: first preoperatively and second postoperatively, when patients were moved to wards. The following five parameters of RV systolic function were used: tricuspid annular plane systolic excursion (TAPSE), systolic tissue Doppler imaging of lateral tricuspid annulus (S'), fractional area change (FAC), RV myocardial performance index (RIMP), and isovolumic acceleration (IVA). Grading of RV diastolic function (RVDD) was done as per guidelines. Paired t test was used for comparing means and x 2 test was used for categorical and ordinal data. The parameters of RV longitudinal function (TAPSE and S') reduced significantly (preoperative 21.93 § 2.80 mm and 13.24 § 2.24 cm/s to postoperative 11.67 § 1.91 mm and 10.31 § 1.56 cm/s, respectively, p < 0.001), whereas parameters of RV global function (FAC, RIMP, and IVA) remained preserved (preoperative 46.75 § 6.80%, 0.34 § 0.06, and 4.66 § 0.87 m/s 2 to postoperative 46.21 § 6.44%, 0.36 § 0.06, and 4.37 § 0.83 m/s 2 ; p values of 0.76, 0.13, and 0.11, respectively). The median grade of RVDD worsened from normal in the preoperative period to pseudo-normal in the postoperative period (p < 0.001). The changes in both RV systolic and diastolic function were similar in patients with normal and reduced left ventricular systolic function. Conclusions: RV function can be assessed in perioperative settings with two-dimensional and tissue Doppler imaging. For systolic function assessment, exclusive measurement of longitudinal parameters might be inadequate; use of complementary global parameters like FAC, RIMP, and IVA is essential to complete the RV assessment after OPCAB. RVDD worsened significantly after OPCABG.
Medicina
Background and Objectives: The role of coronary artery bypass grafting (CABG) on postoperative left ventricular (LV) function in patients with preoperatively preserved left ventricular ejection fraction (LVEF) is still being discussed and only a few studies address this question. This study aimed to assess LV function after CABG in patients with preoperatively preserved LVEF using left ventricular longitudinal strain assessed by 2D speckle tracking imaging (STI). Materials and Methods: Fifty-nine consecutive adult patients with coronary artery disease (CAD) referred for a first-time elective CABG surgery were enrolled in the final analysis of this prospective single-center clinical study. Transthoracic echocardiography (TTE), with conventional measures and STI measures, was performed within 1 week before CABG as well as 4 months after surgery. Patients were divided into groups based on their preoperative global longitudinal strain (GLS) value. Differences in systolic and diastolic p...
The American Journal of Cardiology, 2003
Thallium-201 (Tl-201) imaging and dobutamine stress echocardiography (DSE) are the most frequently used tests in the clinical setting for assessing viability. However, Tl-201 has a suboptimal specificity and DSE a suboptimal sensitivity to predict functional improvement after revascularization. F18-fluorodeoxyglucose (FDG) imaging is considered highly accurate, but availability is limited. Sequential imaging of Tl-201 and DSE may improve accuracy for assessing viability and may be comparable to FDG. Forty-seven patients with ischemic cardiomyopathy underwent Tl-201 single-photon emission computed tomography (SPECT) at rest (4-hour delayed imaging), DSE, and FDG SPECT before bypass surgery. Sensitivity, specificity, and accuracy of 2 sequential strategies were compared with those of FDG SPECT. Strategy 1 considered Tl-201 imaging as the first step, followed by DSE in patients with an intermediate likelihood of viability on Tl-201. Strategy 2 considered DSE as the first step, followed by Tl-201 imaging. Left ven-tricular ejection fraction was assessed before and 6 months after revascularization, and improvement of >5% was considered significant. Tl-201 had a high sensitivity (95%, p <0.05 vs DSE) with a low specificity (57%, p <0.05 vs DSE). DSE had a low sensitivity (63%, p <0.05 vs Tl-201) with a high specificity (89%, p <0.05 vs Tl-201). Both strategies 1 and 2 resulted in high sensitivities (89% and 89%, respectively) and high specificities (89% and 86%, respectively), compared with FDG SPECT (sensitivity 89%, specificity 86%). Sequential testing by Tl-201 SPECT and DSE has a comparable accuracy to FDG SPECT to predict improvement in left ventricular ejection fraction after revascularization. In centers without access to FDG, sequential imaging with Tl-201 and DSE offers an accurate alternative for assessing myocardial viability. ᮊ2003 by Excerpta Medica, Inc.
Selective right ventricular impairment following coronary artery bypass graft surgery
European Journal of Cardio-Thoracic Surgery, 2009
Background: The right ventricle (RV) may be selectively impaired following coronary artery bypass graft (CABG) surgery. We tested this hypothesis in two study parts: a prospective cohort undergoing CABG, and a retrospective cross-sectional cohort of heart-failure patients with and without a history of CABG. Methods: In the prospective study, 20 patients undergoing CABG had echocardiography prior to surgery and 3 months postoperatively. In the retrospective study, 101 patients with established heart failure underwent echocardiography, 40 of whom had undergone previous CABG and 61 of whom had not. Myocardial tissue Doppler velocities were used as a measure of left and right ventricular function. To adjust for varying degrees of overall cardiac impairment, we calculated the ratio between the velocities of the RV and left ventricle (LV). Results: In the prospective study, there was a significant fall in RV:LV ratio following CABG surgery. For S 0 , the ratio fell from 2.27 to 1.13 (50%, p < 0.0001), for E 0 from 1.49 to 0.94 (37%, p < 0.0001) and for A 0 from 1.66 to 1.05 (37%, p < 0.0001). In the retrospective study, the RV:LV ratio was lower in the CABG group compared with the non-CABG group for S 0 (by 32%, p < 0.001), E 0 (by 39%, p < 0.001) and A 0 (by 37%, p < 0.001). In the retrospective study, even when the CABG patients were compared with the ischaemic aetiology heart-failure patients without CABG, a similar relative impairment was seen: 25% in S 0 ( p < 0.001), 34% in E 0 ( p < 0.001) and by 38% in A 0 ( p < 0.002). Conclusions: Both prospectively and crosssectionally, there is evidence of substantial, selective right ventricular impairment following CABG. These features cannot be explained simply by some general feature of ischaemia and, therefore, must be a consequence of surgery. #
Circulation Journal
revascularization (IR) in patients with LV dysfunction due to ischemic heart disease. 5,9 In the present study, we investigated the long-term results after CR and IR in patients with LV dysfunction who underwent CABG. Methods We studied a consecutive series of 111 patients with LVEF ≤35% who underwent CABG at Mitsui Memorial Hospital between January 1994 and January 2014. The inclusion criterion was isolated first-time CABG. Exclusion criteria were previous cardiac surgery, combined procedures, recent myocardial infarction (MI), and cardiogenic shock at the time of index procedure. LVEF was preoperatively measured on echocardiography using the Simpson biplane method in all patients. The Institutional Review Board approved this retrospective study, and the need for written B ased on the current guidelines, coronary artery bypass grafting (CABG) is recommended as the preferred or reasonable therapy of choice for significant coronary artery disease (CAD) and severe left ventricular (LV) dysfunction (LV ejection fraction [LVEF] ≤0.35). 1,2 The results of the Surgical Treatment for Ischemic Heart Failure trial has supported these recommendations because of the long-term survival benefit of CABG over medical therapy in patients with significant CAD and severe LV dysfunction. 3,4 Therefore, CABG is considered the standard treatment for ischemic LV dysfunction; complete revascularization (CR) in such patients, however, remains controversial. Although CR is one of the most important goals of CABG, 5,6 CR is not always realistically achievable due to the variations in the complexity of coronary lesions as well as in the patient clinical status and characteristics, particularly in patients with LV dysfunction. 7,8 In addition, recent guidelines do not formally address the issue of CR in detail, and very few clinical studies to date have been conducted to evaluate the impact of CR vs. incomplete Editorial p 25