Prediction of left ventricular ejection fraction improvement in patients with ischemic cardiomyopathy after coronary artery bypass grafting based on cardiac magnetic resonance

Kui Zhang; Wei Fu; Qinyi Dai; Taoshuai Liu; Jubing Zheng; Yue Song; Hongkai Zhang; Jumatay Biekan; Ran Dong

doi:10.21037/cdt-23-220

Prediction of left ventricular ejection fraction improvement in patients with ischemic cardiomyopathy after coronary artery bypass grafting based on cardiac magnetic resonance

Cardiovasc Diagn Ther. 2023 Dec 15;13(6):1003-1018. doi: 10.21037/cdt-23-220. Epub 2023 Dec 6.

Authors

Kui Zhang^#¹, Wei Fu^#¹, Qinyi Dai², Taoshuai Liu¹, Jubing Zheng¹, Yue Song¹, Hongkai Zhang², Jumatay Biekan³, Ran Dong¹

Affiliations

¹ Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
² Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
³ Circle Cardiovascular Imaging, Calgary, Alberta, Canada.

^# Contributed equally.

Abstract

Background: To investigate the risk factors of left ventricular ejection fraction (LVEF) improvement in patients with ischemic cardiomyopathy (ICM) after coronary artery bypass grafting (CABG), and to construct a model that predicts LVEF improvement.

Methods: A retrospective analysis was performed on 106 ICM patients who received CABG and underwent cardiac magnetic resonance (CMR) at Beijing Anzhen Hospital, Capital Medical University from January 2017 to June 2022. Patients were divided into two groups with improved LVEF and no improved LVEF based on the results of postoperative 6-month transthoracic echocardiography. To analyze the risk factors affecting the LVEF non-improvement after CABG and establish a prediction model.

Results: There was LVEF non-improvement in 30.2% (32/106) of patients. Multivariate analysis showed that the number of transmural scar segments and left ventricular end-systolic volume index (LVESVI) were independent risk factors in LVEF non-improvement after CABG [odds ratio (OR) =2.398, 95% confidence interval (CI): 1.607-3.579, P<0.001; OR =1.036, 95% CI: 1.009-1.063, P=0.008]. The model is built and internally verified. ROC showed that the area under the curve (AUC) was 0.866 (95% CI: 0.792-0.940), calibration curve showed that the probability predicted by the model matched well with the clinical results, and decision curve analysis (DCA) showed that the model had good clinical applicability. During the mean follow-up time of 1.5 years, the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) in the LVEF non-improvement group was higher (5.4% vs. 25.0%, P=0.009), and the NYHA grading was higher (P=0.016), when compared to the LVEF improvement group.

Conclusions: The prediction model based on the number of transmural scar segments and LVESVI has good diagnostic efficacy. Our findings help to identify patients with improved LVEF and thus guide the selection of clinical treatment strategies.

Keywords: Ischemic cardiomyopathy (ICM); cardiac magnetic resonance (CMR); coronary artery bypass grafting (CABG); left ventricular ejection fraction non-improvement (LVEF non-improvement); prediction model.