Effect of improvement in left ventricular ejection fraction on long-term survival in revascularized patients with ischaemic left ventricular systolic dysfunction

Kruti Joshi, Irshad Alam, Emily Ruden, Irmina Gradus-Pizlo, Jothiharan Mahenthiran, Masoor Kamalesh, Harvey Feigenbaum, Stephen Sawada

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Aims: The importance of improvement in the ejection fraction to the prognosis of revascularized patients with ischaemic left ventricular (LV) dysfunction is uncertain. Methods and results: Eighty-seven patients with ischaemic LV dysfunction (mean ejection fraction 29 ± 8% by biplane Simpson's) had dobutamine echocardiography before revascularization (coronary bypass graft surgery-81, percutaneous intervention-6). Follow-up echocardiograms were performed a mean of 4.8±6.2 months after revascularization. An 8% increase in the ejection fraction was considered significant (two times the inter-observer difference of 3.7%). Patients were followed for cardiac death. During a mean follow-up of 5.2 ± 3.9 years, there were 20 (23%) cardiac deaths. Class 3/4 heart failure, increasing low-dose wall motion score, increasing % non-viable myocardium, and digoxin use in follow-up were univariate predictors of death. Beta-blocker use, ejection fraction improvement, angina, aspirin use, and increasing fractional shortening were univariate predictors of survival. Ejection fraction improvement [P = 0.02, hazard ratio (HR) = 0.26], digoxin use in follow-up (P = 0.006, HR = 5.85), and low-dose wall motion score (P = 0.017, HR = 4.78) were independent predictors of outcome. In step-wise analysis, low-dose wall motion score added incremental prognostic value to ejection fraction improvement (P = 0.003), and digoxin use in follow-up (P = 0.003) added incremental value to a low-dose score and ejection fraction improvement Conclusion: Ejection fraction improvement is an independent predictor of long-term outcome in revascularized patients but viability (low-dose wall motion score) and digoxin use in follow-up are also independent predictors and add incremental prognostic value to ejection fraction improvement.

Original languageEnglish
Pages (from-to)454-460
Number of pages7
JournalEuropean Journal of Echocardiography
Volume12
Issue number6
DOIs
StatePublished - Jun 2011

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Digoxin
Left Ventricular Dysfunction
Stroke Volume
Survival
Dobutamine
Aspirin
Echocardiography
Myocardium
Heart Failure
Transplants

Keywords

  • Ejection fraction improvement
  • Ischaemic cardiomyopathy
  • Prognosis
  • Revascularization

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Effect of improvement in left ventricular ejection fraction on long-term survival in revascularized patients with ischaemic left ventricular systolic dysfunction. / Joshi, Kruti; Alam, Irshad; Ruden, Emily; Gradus-Pizlo, Irmina; Mahenthiran, Jothiharan; Kamalesh, Masoor; Feigenbaum, Harvey; Sawada, Stephen.

In: European Journal of Echocardiography, Vol. 12, No. 6, 06.2011, p. 454-460.

Research output: Contribution to journalArticle

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abstract = "Aims: The importance of improvement in the ejection fraction to the prognosis of revascularized patients with ischaemic left ventricular (LV) dysfunction is uncertain. Methods and results: Eighty-seven patients with ischaemic LV dysfunction (mean ejection fraction 29 ± 8{\%} by biplane Simpson's) had dobutamine echocardiography before revascularization (coronary bypass graft surgery-81, percutaneous intervention-6). Follow-up echocardiograms were performed a mean of 4.8±6.2 months after revascularization. An 8{\%} increase in the ejection fraction was considered significant (two times the inter-observer difference of 3.7{\%}). Patients were followed for cardiac death. During a mean follow-up of 5.2 ± 3.9 years, there were 20 (23{\%}) cardiac deaths. Class 3/4 heart failure, increasing low-dose wall motion score, increasing {\%} non-viable myocardium, and digoxin use in follow-up were univariate predictors of death. Beta-blocker use, ejection fraction improvement, angina, aspirin use, and increasing fractional shortening were univariate predictors of survival. Ejection fraction improvement [P = 0.02, hazard ratio (HR) = 0.26], digoxin use in follow-up (P = 0.006, HR = 5.85), and low-dose wall motion score (P = 0.017, HR = 4.78) were independent predictors of outcome. In step-wise analysis, low-dose wall motion score added incremental prognostic value to ejection fraction improvement (P = 0.003), and digoxin use in follow-up (P = 0.003) added incremental value to a low-dose score and ejection fraction improvement Conclusion: Ejection fraction improvement is an independent predictor of long-term outcome in revascularized patients but viability (low-dose wall motion score) and digoxin use in follow-up are also independent predictors and add incremental prognostic value to ejection fraction improvement.",
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AB - Aims: The importance of improvement in the ejection fraction to the prognosis of revascularized patients with ischaemic left ventricular (LV) dysfunction is uncertain. Methods and results: Eighty-seven patients with ischaemic LV dysfunction (mean ejection fraction 29 ± 8% by biplane Simpson's) had dobutamine echocardiography before revascularization (coronary bypass graft surgery-81, percutaneous intervention-6). Follow-up echocardiograms were performed a mean of 4.8±6.2 months after revascularization. An 8% increase in the ejection fraction was considered significant (two times the inter-observer difference of 3.7%). Patients were followed for cardiac death. During a mean follow-up of 5.2 ± 3.9 years, there were 20 (23%) cardiac deaths. Class 3/4 heart failure, increasing low-dose wall motion score, increasing % non-viable myocardium, and digoxin use in follow-up were univariate predictors of death. Beta-blocker use, ejection fraction improvement, angina, aspirin use, and increasing fractional shortening were univariate predictors of survival. Ejection fraction improvement [P = 0.02, hazard ratio (HR) = 0.26], digoxin use in follow-up (P = 0.006, HR = 5.85), and low-dose wall motion score (P = 0.017, HR = 4.78) were independent predictors of outcome. In step-wise analysis, low-dose wall motion score added incremental prognostic value to ejection fraction improvement (P = 0.003), and digoxin use in follow-up (P = 0.003) added incremental value to a low-dose score and ejection fraction improvement Conclusion: Ejection fraction improvement is an independent predictor of long-term outcome in revascularized patients but viability (low-dose wall motion score) and digoxin use in follow-up are also independent predictors and add incremental prognostic value to ejection fraction improvement.

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