Changes of Left Ventricular Systolic Function in Patients Undergoing Coronary Artery Bypass Grafting

Vasil Papestiev; Sasko Jovev; Marjan Sokarovski; Petar Risteski; Valentina Andova; Vangel Zdraveski; Kujtim Dzeljilji; Sonja Grazhdani; Ljubica Georgievska-Ismail

doi:10.3889/oamjms.2019.849

Authors

Vasil Papestiev University Clinic for Cardiac Surgery, Medical Faculty, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
Sasko Jovev University Clinic for Cardiac Surgery, Medical Faculty, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
Marjan Sokarovski University Clinic for Cardiac Surgery, Medical Faculty, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
Petar Risteski University Clinic for Cardiac Surgery, Medical Faculty, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia; Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt, Germany
Valentina Andova University Clinic of Cardiology, Medical Faculty, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
Vangel Zdraveski University Clinic for Cardiac Surgery, Medical Faculty, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
Kujtim Dzeljilji University Clinic for Cardiac Surgery, Medical Faculty, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
Sonja Grazhdani University Clinic for Cardiac Surgery, Medical Faculty, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
Ljubica Georgievska-Ismail University Clinic of Cardiology, Medical Faculty, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia

DOI:

https://doi.org/10.3889/oamjms.2019.849

Keywords:

Coronary artery bypass graft surgery, Echocardiography, Left ventricular function

Abstract

AIM: This prospective study was designed to evaluate the changes in left ventricular (LV) systolic function after coronary artery bypass grafting (CABG) in patients with both normal and abnormal pre-operative systolic function.

METHODS: During the period from October 2017 to October 2018, forty-seven consecutive patients undergoing CABG were enrolled in this prospective study. Transthoracic echocardiography was performed within 1 week before CABG as well as 4 to 6 months after surgery. All measurements were made by a single experienced investigator.

RESULTS: While the mean LV ejection fraction (LVEF) showed neither improvement nor significant reduction in the whole group of patients following CABG (from 54.21 Â± 15.36 to 53.66 Â± 11.56%, p = 0.677), significant improvement in LVEF was detected in the subgroup of patients with pre-operative LV dysfunction (from 40.05 Â± 8.65 to 45.85 Â± 9.04%, p = 0.008). On the other hand, there was a significant decline in LEFT in the subgroup of patients with normal pre-operative LEFT (from 64.70 Â± 9.72 to 59.44 Â± 9.75%, p = 0.008). As for the other parameters of systolic function, significant decrease in LV end-diastolic volume index (LVEDVI) (p = 0.001), LV end-systolic volume index (LVESVI) (p = 0.0001), wall motion score index (WMSI) (p = 0.013) and LVmass index in male patients (p = 0.011) was shown only in patients with decreased LVEF after CABG. Patients with improved postoperative LVEF (53.2% of all patients) had significantly lower baseline LVEF (p = 0.0001), higher LVESVI (0.009) and higher WMSI (p = 0.006) vs patients with worsened postoperative LVEF (38.3% of all patients). Postoperative improvement of LVEF was correlated with stabile angina, lack of preoperative myocardial infarction and smoking, higher baseline WMSI, higher LV internal diameters and indexed volumes in diastole and systole and lower baseline LVEF. In stepwise linear regression analysis the value of baseline LVEF appeared as independent predictor of improved LVEF after CABG (B = 0,836%; 95% CI 0.655-1.017; p = 0.0001).

CONCLUSION: Our study showed that LVEF, internal baseline diameters and indexed volumes of LV in diastole and systole are important determinants of postoperative change in LVEF. In patients with preoperative depressed myocardial function, there is an improvement in systolic function, whereas in patients with preserved preoperative myocardial function, the decline in postoperative LVEF was detected.