Cardiac Magnetic Resonance Imaging Predictors of Short-Term Outcomes after High Risk Coronary Surgery

Mohammed J Sheriff; Omar Mouline; Chijen Hsu; Stuart M Grieve; Michael K Wilson; Paul G Bannon; Michael P Vallely; Rajesh Puranik

doi:10.1016/j.hlc.2015.11.011

Cardiac Magnetic Resonance Imaging Predictors of Short-Term Outcomes after High Risk Coronary Surgery

Heart Lung Circ. 2016 Jun;25(6):613-9. doi: 10.1016/j.hlc.2015.11.011. Epub 2016 Jan 18.

Authors

Mohammed J Sheriff¹, Omar Mouline², Chijen Hsu³, Stuart M Grieve⁴, Michael K Wilson⁵, Paul G Bannon⁵, Michael P Vallely⁶, Rajesh Puranik⁷

Affiliations

¹ Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
² The Baird Institute, Sydney, NSW, Australia; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
³ Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Translational Imaging Laboratory, Heart Research Institute & Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia.
⁴ Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Sydney Translational Imaging Laboratory, Heart Research Institute & Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia; Department of Radiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
⁵ The Baird Institute, Sydney, NSW, Australia; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia.
⁶ Sydney Medical School, University of Sydney, Sydney, NSW, Australia; The Baird Institute, Sydney, NSW, Australia; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia.
⁷ Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia. Electronic address: raj.puranik@cmrs.org.au.

PMID: 26839164
DOI: 10.1016/j.hlc.2015.11.011

Abstract

Background: The euroSCORE II is a widely used pre-coronary artery bypass graft surgery (CAGS) risk score, but its predictive power lacks the specificity to predict outcomes in high-risk patients (<LVEF 40%) due to changes in cardiac surgery case mix, revascularisation techniques and related outcomes in recent years. We investigated the utility of Cardiac Magnetic Resonance Imaging (CMRI) in predicting immediate and six-week outcomes after CAGS.

Methods: Fifty-two consecutive patients with high euroSCORE II (>16) and left ventricular (LV) dysfunction (<40%) based on 2D-echocardiography who underwent CAGS and in whom CMRI (1.5T) was performed preoperatively were retrospectively studied. Cardiac magnetic resonance imaging parameters were assessed in patients who either had complications immediately post-surgery (n=35), six weeks post-surgery (n=20) or were uncomplicated.

Results: The average age of patients recruited was 69±5 years with high euroSCORE II (22±4) and low 2D-echocardiography LV ejection fraction (38%±2%). Cardiac magnetic resonance imaging results demonstrated that those with immediate complications had higher LV scar/infarct burden as a proportion of LV mass (17±3% vs 10±3%; p=0.04) with lower circumferential relaxation index (2.5±0.46 vs 2.8±0.56; p=0.05) compared to those with no complications. Early mortality from surgery was 17% (n=9) and was associated with lower RV stroke volume (55±12 vs 68±18; p=0.03) and higher LV infarct scar/burden (18±2% vs 10±2%, p=0.04). Cardiac magnetic resonance imaging showed patients with complications at six weeks post-surgery had higher LV scar/infarct burden (14.5±2% vs 6.8±2%, p=0.03) compared to those without complications.

Conclusion: Cardiac magnetic resonance imaging preoperative LV and RV parameters are valuable in assessing the likelihood of successful outcomes from CAGS in high-risk patients with LV dysfunction.

Keywords: CMRI; Cardiac magnetic resonance imaging; Coronary Artery Bypass Graft; EuroSCORE II.

Publication types

Clinical Trial
Multicenter Study

MeSH terms

Aged
Cardiomegaly* / diagnostic imaging
Cardiomegaly* / physiopathology
Cardiomegaly* / surgery
Coronary Artery Bypass*
Humans
Magnetic Resonance Imaging*
Middle Aged
Myocardial Infarction* / diagnosis
Myocardial Infarction* / physiopathology
Myocardial Infarction* / surgery
Preoperative Care*
Retrospective Studies
Stroke Volume*