Smaller left ventricular end-systolic diameter and lower ejection fraction at baseline associated with greater ejection fraction improvement after revascularization among patients with left ventricular dysfunction

Shaoping Wang; Yi Lyu; Shujuan Cheng; Yuchao Zhang; Xiaoyan Gu; Ming Gong; Jinghua Liu

doi:10.3389/fcvm.2022.967039

Smaller left ventricular end-systolic diameter and lower ejection fraction at baseline associated with greater ejection fraction improvement after revascularization among patients with left ventricular dysfunction

Front Cardiovasc Med. 2022 Sep 29:9:967039. doi: 10.3389/fcvm.2022.967039. eCollection 2022.

Authors

Shaoping Wang¹, Yi Lyu², Shujuan Cheng¹, Yuchao Zhang¹, Xiaoyan Gu³, Ming Gong⁴, Jinghua Liu¹

Affiliations

¹ Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China.
² Department of Anesthesiology, Minhang Hospital, Fudan University, Shanghai, China.
³ Department of Echocardiography, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China.
⁴ Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China.

Abstract

Objectives: To investigate the predictive roles of pre-operative left ventricular (LV) size and ejection fraction (EF) in EF improvement and outcome following revascularization in patients with coronary artery disease (CAD) and LV dysfunction.

Background: Revascularization may improve EF and long-term outcomes of patients with LV dysfunction. However, the determinants of EF improvement have not yet been investigated comprehensively.

Materials and methods: Patients with EF measurements before and 3 months after revascularization were enrolled in a cohort study (No. ChiCTR2100044378). All patients had baseline EF ≤ 40%. EF improvement was defined as absolute increase in EF > 5%. According to LV end-systolic diameter (LVESD) (severely enlarged or not) and EF (≤35% or of 36-40%) at baseline, patients were categorized into four groups.

Results: A total of 939 patients were identified. A total of 549 (58.5%) had EF improved. Both LVESD [odds ratio (OR) per 1 mm decrease, 1.05; 95% CI, 1.04-1.07; P < 0.001] and EF (OR per 1% decrease, 1.06; 95% CI, 1.03-1.10; P < 0.001) at baseline were predictive of EF improvement after revascularization. Patients with LVESD not severely enlarged and EF ≤ 35% had higher odds of being in the EF improved group in comparison with other three groups both in unadjusted and adjusted analysis (all P < 0.001). The median follow-up time was 3.5 years. Patients with LVESD not severely enlarged and EF ≤ 35% had significantly lower risk of all-cause death in comparison with patients with LVESD severely enlarged and EF ≤ 35% [hazard ratio (HR), 2.73; 95% CI, 1.28-5.82; P = 0.009], and tended to have lower risk in comparison with patients with LVESD severely enlarged and EF of 36-40% (HR, 2.00; 95% CI, 0.93-4.27; P = 0.074).

Conclusion: Among CAD patients with reduced EF (≤ 40%) who underwent revascularization, smaller pre-operative LVESD and lower EF had greatest potential to have EF improvement and better outcome. Our findings imply the indication for revascularization in patients with LV dysfunction who presented with lower EF but smaller LV size.

Keywords: ejection fraction; heart failure; prognosis; remodeling; revascularization.