Left Ventricular Structure is Associated with Postoperative Death After Coronary Artery Bypass Grafting in Patients with Heart Failure with Reduced Ejection Fraction.
Left Ventricular Structure is Associated with Postoperative Death After Coronary Artery Bypass Grafting in Patients with Heart Failure with Reduced Ejection Fraction.
复制标题
左心室结构与射血分数降低的心力衰竭患者冠状动脉搭桥术后死亡相关。
DOI：
10.2147/ijgm.s341145
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发表时间：
2022
影响因子：
2.3
通讯作者：
Dong R
中科院分区：
文献类型：
--
作者：
Yan P;Zhang K;Cao J;Dong R
左心室（LV）结构异常与不良结局之间的关系已在以往的研究中在不同的患者群体中得到证实。然而，左心室结构是否对冠状动脉旁路移植术（CABG）后射血分数降低的心力衰竭（HFrEF）患者具有预测意义仍不确定。本研究回顾性入组了2013年1月至2019年7月期间患有HFrEF并接受CABG的患者。根据超声心动图对左室肥厚（LVH）和左室扩大（LVE）的评价，将患者分为（-）LVH/（-）LVE、（+）LVH/（-）LVE、（-）LVH/（+）LVE和（+）LVH/（+）LVE四种结构类型。本研究共入组了435例连续患者（平均年龄：59.4 ± 9.6岁; 14.9%为女性）。多因素分析显示，LVH（p < 0.001）或LVE（p < 0.001）与术后死亡率独立相关。当LVH和LVE联合分析时，CABG术后死亡风险在（-）LVH/（-）LVE组最低，而在（+）LVH/（-）LVE组则增加（比值比[OR]：7.525; 95%置信区间[CI]：1.827-30.679，p = 0.004），（-）LVH/（+）LVE（OR：7.253; 95% CI：1.950-27.185，p = 0.003）和（+）LVH/（+）LVE（OR：9.547; 95% CI：2.726-34.805，p < 0.001），独立于其他危险因素。在基线模型中增加左心室结构类型对术后死亡率的预测值有增加作用（AUC：基线模型，0.838 vs基线模型+ LV结构类型，0.901，用于比较的p = 0.010;无类别净重新分类改善（NRI）：0.764，p < 0.001;综合辨别改善（IDI）：0.061，p = 0.007）。在HFrEF患者中，LVH和LVE与CABG术后死亡风险增加相关。将LV结构模式与LVH和LVE分类有助于风险分层，并提供增量预测能力。临床上需要常规超声心动图评估LVH和LVE。
The relationship between abnormal left ventricular (LV) structure and adverse outcomes has been confirmed in diverse patient groups in previous studies. However, it remains uncertain whether LV structure has predictive implications in heart failure with reduced ejection fraction (HFrEF) patients with coronary artery bypass grafting (CABG). This study retrospectively enrolled patients who had HFrEF and underwent CABG between January 2013 and July 2019. According to LV hypertrophy (LVH) and LV enlargement (LVE) assessed by echocardiography, patients were classified into four LV structure types: (-)LVH/(-)LVE, (+)LVH/(-)LVE, (-)LVH/(+)LVE, and (+)LVH/(+)LVE. A total of 435 consecutive patients (mean age: 59.4 ± 9.6 years; 14.9% female) were enrolled in the present study. Examined independently, either LVH (p < 0.001) or LVE (p < 0.001) was independently associated with postoperative mortality in multivariate analysis. When LVH and LVE were analyzed in combination, the risk of mortality after CABG was lowest in (-)LVH/(-)LVE and increased with (+)LVH/(-)LVE (odds ratio [OR]: 7.525; 95% confidence interval [CI]: 1.827–30.679, p = 0.004), (-)LVH/(+)LVE (OR: 7.253; 95% CI: 1.950–27.185, p = 0.003), and (+)LVH/(+)LVE (OR: 9.547; 95% CI: 2.726–34.805, p < 0.001), independent of other risk factors. Adding LV structural types to the baseline model gained an incremental effect on the predictive value for postoperative mortality (AUC: baseline model, 0.838 vs baseline model + LV structural types, 0.901, p for comparison = 0.010; category‐free net reclassification improvement (NRI): 0.764, p < 0.001; integrated discrimination improvement (IDI): 0.061, p = 0.007). LVH and LVE were associated with an increased risk of postoperative mortality after CABG in patients with HFrEF. Categorizing LV structural patterns with LVH and LVE contributes to risk stratification and provides incremental predictive ability. Routine echocardiographic assessment of LVH and LVE is needed in clinical practice.