Thorac Cardiovasc Surg
DOI: 10.1055/a-2637-0964
Original Cardiovascular

The Geometry of Survival: Left Ventricular Mass Index's Prognostic Value in Coronary Surgery

1   Department of Cardiovascular Surgery, SBU Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Hospital, Istanbul, Turkey
,
Rezan Aksoy
1   Department of Cardiovascular Surgery, SBU Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Hospital, Istanbul, Turkey
,
Zihni Mert Duman
2   Department of Cardiovascular Surgery, Elazig Fethi Sekin Sehir Hastanesi, Elazığ, Turkey
,
Recep Çalışkan
1   Department of Cardiovascular Surgery, SBU Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Hospital, Istanbul, Turkey
,
Kandemir Baş
1   Department of Cardiovascular Surgery, SBU Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Hospital, Istanbul, Turkey
,
Cem Aydoğdu
1   Department of Cardiovascular Surgery, SBU Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Hospital, Istanbul, Turkey
,
Cevdet Ugur Kocogullari
1   Department of Cardiovascular Surgery, SBU Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Hospital, Istanbul, Turkey
› Author Affiliations

Abstract

Background

This study explores the impact of left ventricular mass and geometry on the prognosis of patients undergoing coronary artery bypass grafting. Left ventricular hypertrophy is a known risk factor for cardiovascular complications, yet its role in surgical outcomes remains underexplored.

Methods

A retrospective cohort of 494 elective coronary artery bypass grafting patients treated between 2013 and 2018 was analyzed. Left ventricular mass was calculated using the Devereux formula, and patients were divided into normal and increased left ventricular mass index groups. Mortality rates, postoperative complications, and echocardiographic parameters were evaluated.

Results

Patients with increased left ventricular mass exhibited significantly higher 5-year mortality rates (27.2 vs. 11.5%, p < 0.001), postoperative atrial fibrillation (24.8 vs. 16.0%, p = 0.018), and carotid stenosis (21.8 vs. 12.5%, p = 0.006). Elevated preoperative biomarkers, including creatinine and C-reactive protein, were observed in this group, with sustained impairment in postoperative kidney function. However, no significant differences in 30-day, 1-year, or 3-year mortality rates were detected.

Conclusion

Left ventricular mass and geometry independently predict long-term outcomes in coronary artery bypass grafting patients. Targeted strategies to mitigate left ventricular remodeling may enhance postoperative outcomes. Future research should focus on therapeutic interventions to reverse adverse left ventricular changes and optimize patient survival and quality of life.



Publication History

Received: 25 April 2025

Accepted: 13 June 2025

Article published online:
01 July 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 
  • References

  • 1 Benjamin EJ, Blaha MJ, Chiuve SE. et al; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2017 update: a report from the American Heart Association. Circulation 2017; 135 (10) e146-e603
  • 2 Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med 1990; 322 (22) 1561-1566
  • 3 Vakili BA, Okin PM, Devereux RB. Prognostic implications of left ventricular hypertrophy. Am Heart J 2001; 141 (03) 334-341
  • 4 Nashef SA, Roques F, Sharples LD. et al. EuroSCORE II. Eur J Cardiothorac Surg 2012; 41 (04) 734-744 , discussion 744–745
  • 5 Kannel WB, Dannenberg AL, Levy D. Population implications of electrocardiographic left ventricular hypertrophy. Am J Cardiol 1987; 60 (17) 85I-93I
  • 6 Devereux RB, Alonso DR, Lutas EM. et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 1986; 57 (06) 450-458
  • 7 Bai W, Suzuki H, Huang J. et al. A population-based phenome-wide association study of cardiac and aortic structure and function. Nat Med 2020; 26 (10) 1654-1662
  • 8 Abdi-Ali A, Miller RJH, Southern D. et al. LV mass independently predicts mortality and need for future revascularization in patients undergoing diagnostic coronary angiography. JACC Cardiovasc Imaging 2018; 11 (03) 423-433
  • 9 Seko Y, Kato T, Haruna T. et al. Association between atrial fibrillation, atrial enlargement, and left ventricular geometric remodeling. Sci Rep 2018; 8 (01) 1-8
  • 10 Lang RM, Badano LP, Mor-Avi V. et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015; 28 (01) 1-39.e14
  • 11 Weber KT, Janicki JS, Shroff SG, Pick R, Chen RM, Bashey RI. Collagen remodeling of the pressure-overloaded, hypertrophied nonhuman primate myocardium. Circ Res 1988; 62 (04) 757-765
  • 12 Bikkina M, Levy D, Evans JC. et al. Left ventricular mass and risk of stroke in an elderly cohort. The Framingham Heart Study. JAMA 1994; 272 (01) 33-36
  • 13 Chatterjee S, Bavishi C, Sardar P. et al. Meta-analysis of left ventricular hypertrophy and sustained arrhythmias. Am J Cardiol 2014; 114 (07) 1049-1052
  • 14 Wachtell K, Lehto M, Gerdts E. et al. Angiotensin II receptor blockade reduces new-onset atrial fibrillation and subsequent stroke compared to atenolol: the Losartan Intervention For End Point Reduction in Hypertension (LIFE) study. J Am Coll Cardiol 2005; 45 (05) 712-719
  • 15 Zhu P, Dai Y, Qiu J, Xu H, Liu J, Zhao Q. Prognostic implications of left ventricular geometry in coronary artery bypass grafting patients. Quant Imaging Med Surg 2020; 10 (12) 2274-2284
  • 16 de Simone G, Verdecchia P, Pede S, Gorini M, Maggioni AP. Prognosis of inappropriate left ventricular mass in hypertension: the MAVI study. Hypertension 2002; 40 (04) 470-476
  • 17 Weber KT, Brilla CG. Pathological hypertrophy and cardiac interstitium. Fibrosis and renin-angiotensin-aldosterone system. Circulation 1991; 83 (06) 1849-1865
  • 18 Verdecchia P, Porcellati C, Reboldi G. et al. Left ventricular hypertrophy as an independent predictor of acute cerebrovascular events in essential hypertension. Circulation 2001; 104 (17) 2039-2044
  • 19 Stack AG, Saran R. Clinical correlates and mortality impact of left ventricular hypertrophy among new ESRD patients in the United States. Am J Kidney Dis 2002; 40 (06) 1202-1210
  • 20 Stewart GA, Gansevoort RT, Mark PB. et al. Electrocardiographic abnormalities and uremic cardiomyopathy. Kidney Int 2005; 67 (01) 217-226
  • 21 Dzau VJ. The role of mechanical and humoral factors in growth regulation of vascular smooth muscle and cardiac myocytes. Curr Opin Nephrol Hypertens 1993; 2 (01) 27-32
  • 22 Levin A, Thompson CR, Ethier J. et al. Left ventricular mass index increase in early renal disease: impact of decline in hemoglobin. Am J Kidney Dis 1999; 34 (01) 125-134
  • 23 Park SK, Jung JY, Kang JG, Hong HP, Oh CM. Association of left ventricular hypertrophy with hemoglobin levels in nonanemic and anemic populations. Cardiology 2020; 145 (08) 485-491