J Korean Med Sci.  2017 Dec;32(12):2009-2015. 10.3346/jkms.2017.32.12.2009.

Cardiac Magnetic Resonance Predictor of Ventricular Function after Surgical Coronary Revascularization

• Hwang HY
• Yeom SY
• Choi JW
• Oh SJ
• Park EA
• Lee W
• Kim KB

• KMID: 2396379
• DOI: http://doi.org/10.3346/jkms.2017.32.12.2009

Abstract

We evaluated echocardiographic changes of left ventricular (LV) function in coronary artery bypass grafting (CABG) patients with LV dysfunction, and examined cardiac magnetic resonance (CMR) parameters associated with improved LV function. Seventy-seven CABG patients presenting with decreased LV ejection fraction (LVEF, ≤ 35%) and who underwent preoperative gadolinium-enhanced CMR were enrolled. A 16-segment model was used to analyze CMR imaging. A viable myocardial segment was defined as ≤ 50% transmural extent of late gadolinium enhancement. Serial echocardiographic examinations were performed preoperatively, pre-discharge (median 6 days), and during postoperative year 1 (median 11 months) in 70 patients. Predictors of absolute increase in LVEF (≥ 5%) and proportional changes in LVEF were analyzed. Serial echocardiography demonstrated that LVEF measured 28.6% ± 5.4% preoperatively, 31.5% ± 8.0% median 6 days, and 42.1% ± 10.5% median 11 months postoperatively. Absolute increase of LVEF was observed in 27 patients at pre-discharge and in 24 patients by median 11 months. Proportional changes in LVEF at postoperative median 6 days and 11 months were 14% ± 28% and 57% ± 45%, respectively. The median number of viable myocardial segments was 14 (range, 9-16) in the 16 segment CMR model. Multivariable models demonstrated that the median number of overall viable myocardial segments (≥ 14) in preoperative CMR was associated with absolute increase (P = 0.046) and proportional changes (P = 0.005) in LVEF. In conclusion, the number of viable myocardial segments (≥ 14) in preoperative CMR predicted LV function improvement after CABG in patients with LV dysfunction.

Keyword

Coronary Artery Bypass Graft Surgery; Ventricular Dysfunction; Cardiac Magnetic Resonance; Late Gadolinium Enhancement

MeSH Terms

Coronary Artery Bypass
Echocardiography
Gadolinium
Humans
Ventricular Dysfunction
Ventricular Function*
Gadolinium

Figure

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  Fig. 1 Summary flow diagram showing patient enrollment. CABG = coronary artery bypass grafting, CMR = cardiac magnetic resonance.

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  Fig. 2 Serial changes in LVEF at Pre and Post periods, and during the first year postoperative FU. (A) LVEF changes in 51 patients who showed absolute increase of LVEF. (B) LVEF changes in 19 patients in whom LVEF was not improved. LVEF = left ventricular ejection fraction, Pre = preoperative, Post = early postoperative, FU = follow-up.

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  Fig. 3 Comparison of event-free survivals between the patients with number of viable segments ≥ 14 (red line) and those with viable segments < 14 (blue line). (A) overall survival. (B) freedom from composite event of cardiac death or readmission due to congestive heart failure.

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