Cardiac imaging improves risk stratification in high-risk patients undergoing surgical revascularization

Journal of Cardiovascular Medicine
Alessia GimelliPaolo Marzullo

Abstract

In patients with ischaemic left ventricular dysfunction, multivessel disease and dominance of necrotic myocardium, perioperative mortality due to coronary artery bypass grafting is still a rather unclear issue. The aim of this study was to analyse the impact of different imaging variables in predicting perioperative mortality. We selected a group of 259 patients who had preoperatively been defined as 'high-risk patients' and who showed a mostly necrotic myocardium as detected by thallium-201 myocardial scintigraphy. Mean ejection fraction was 0.26 +/- 0.07. In a 16-segment model, the mean number of scintigraphic necrotic myocardial segments was 5.07 +/- 1.09, echocardiographic end-diastolic diameter was 29.41 +/- 2.38 mm/m2 and wall motion score index was 2.29 +/- 0.19. Perioperative mortality increased along with the increase in the number of necrotic segments: 5/105 (5%), 4/63 (6%), 8/52 (15%) and 8/39 (20%) patients with four, five, six and seven necrotic segments, respectively. The analysis of additional variables in survived vs. deceased patients demonstrated a significant difference in echocardiographic end-diastolic diameter (27 +/- 8 vs. 31.9 +/- 1.9 mm/m2, P < 0.001) and in wall motion score index (2.2 +/- 0.1 vs. 2.4 ...Continue Reading

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