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Thorac Cardiovasc Surg 2024; 72(06): 441-448
DOI: 10.1055/a-2228-7104
Original Cardiovascular

Impact of Myocardial Viability on Long-term Outcomes after Surgical Revascularization

Authors

  • Suk Ho Sohn

    1   Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea

  • Yoonjin Kang

    1   Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea

  • Ji Seong Kim

    1   Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea

  • Eun-Ah Park

    2   Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea

  • Whal Lee

    2   Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea

  • Ho Young Hwang

    1   Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Abstract

Background This study was conducted to evaluate whether myocardial viability assessed with cardiac magnetic resonance (CMR) affected long-term clinical outcomes after coronary artery bypass grafting (CABG) in patients with ischemic cardiomyopathy (ICMP).

Methods Preoperative CMR with late gadolinium enhancement (LGE) was performed in 103 patients (64.9 ± 10.1 years, male:female = 82:21) with 3-vessel disease and left ventricular dysfunction (ejection fraction ≤ 0.35). Transmural extent of LGE was evaluated on a 16-segment model, and transmurality was graded on a 5-point scale: grades—0, absence; 1, 1 to 25%; 2, 26 to 50%; 3, 51 to 75%; 4, 76 to 100%. Median follow-up duration was 65.5 months (interquartile range = 27.5–95.3 months). Primary endpoint was the composite of all-cause mortality or hospitalization for congestive heart failure.

Results Operative mortality was 1.9%. During the follow-up, all-cause mortality and readmission for congestive heart failure occurred in 29 and 8 patients, respectively. The cumulative incidence of the primary endpoint was 31.3 and 46.8% at 5 and 10 years, respectively. Multivariable analysis demonstrated that the number of segments with LGE grade 4 was a significant risk factor (hazard ratio 1.42, 95% confidence interval 1.10–1.83, p = 0.007) for the primary endpoint among the variables assessed by CMR. Other risk factors included age, dialysis, chronic obstructive pulmonary disease, and EuroSCORE II.

Conclusion The number of myocardial segments with transmurality of LGE >75% might be a prognostic factor associated with the composite of all-cause mortality or hospitalization for congestive heart failure after CABG in patients with 3-vessel disease and ICMP.

Keywords

coronary artery bypass grafting - ischemic cardiomyopathy - cardiac magnetic resonance - late gadolinium enhancement - long-term outcomes

Note

This paper was presented at the AATS 103rd Annual Meeting.


Authors' Contribution

Conceptualization: S.H.S., H.Y.H.; Data curation: S.H.S., Y.K., J.S.K., E-A.P., W.L., H.Y.H.; Investigation: S.H.S.; Methodology: E-A.P., W.L., H.Y.H.; Validation: H.Y.H.; Writing—original draft: S.H.S.; Writing—review and editing: H.Y.H.


Supplementary Material



Publication History

Received: 24 August 2023

Accepted: 29 November 2023

Accepted Manuscript online:
13 December 2023

Article published online:
22 January 2024

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