| Incremental Value of the Preoperative Echocardiogram to Predict Mortality and Major Morbidity in Coronary Artery Bypass Surgery. | |
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MedLine Citation:
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PMID: 23239840 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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BACKGROUND: Although echocardiography is commonly performed before coronary artery bypass surgery (CABG), there has yet to be a study examining the incremental prognostic value of a complete echocardiogram. METHODS AND RESULTS: Patients undergoing isolated CABG at two hospitals were divided into derivation and validation cohorts. A panel of quantitative echocardiographic parameters was measured. Clinical variables were extracted from the STS database. The primary outcome was in-hospital mortality or major morbidity, and the secondary outcome was long-term all-cause mortality. The derivation cohort consisted of 667 patients with a mean age of 67.2±11.1 years and 22.8% females. The following echocardiographic parameters were found to be optimal predictors of mortality or major morbidity: severe diastolic dysfunction as evidenced by restrictive filling (OR 2.96; 95% CI 1.59,5.49), RV dysfunction as evidenced by fractional area change <35% (OR 3.03; 95% CI 1.28,7.20) or myocardial performance index >0.40 (OR 1.89; 95% CI 1.13,3.15). These results were confirmed in the validation cohort of 187 patients. When added to the STS risk score, the echocardiographic parameters resulted in a net improvement in model discrimination and reclassification with a change in c-statistic from 0.68 to 0.73 and an integrated discrimination improvement of 5.9% (95% CI 2.8%, 8.9%). In the Cox proportional hazards model, RV dysfunction and pulmonary hypertension were independently predictive of mortality over 3.2 years of follow-up. CONCLUSIONS: Preoperative echocardiography, in particular RV dysfunction and restrictive LV filling, provides incremental prognostic value in identifying patients at higher risk of mortality or major morbidity after CABG. |
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Authors:
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Jonathan Afilalo; Aidan W Flynn; Avi Shimony; Lawrence G Rudski; Arvind K Agnihotri; Jean-Francois Morin; Cristina Castrillo; David M Shahian; Michael H Picard |
Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-12-12 |
Journal Detail:
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Title: Circulation Volume: - ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2012 Dec |
Date Detail:
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Created Date: 2012-12-14 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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1 MGH, Harvard University, Boston, MA & Jewish General Hosp, McGill University, Montreal, Canada; |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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