Abstract 3043: Myocardial Viability and Cardiac Dyssynchrony are Strong Predictors of Perioperative Mortality in High-Risk Patients (EuroSCORE more than 10%) with Ischemic Cardiomyopathy Undergoing CABG
Objective: To test the hypothesis that assessment of myocardial viability and left ventricular (LV) dyssynchrony will predict perioperative mortality in high-risk patients with ischemic LV dysfunction undergoing CABG.
Methods: The study consisted of 79 consecutive patients with ischemic cardiomyopathy (age 65±9y; 84% males; ejection fraction 30±6%) and logistic EuroSCORE > 10% undergoing CABG. Myocardial viability in dysfunctional segments was assessed by delayed contrast-enhanced MRI. LV dyssynchrony was calculated by tissue-Doppler imaging from measurements of regional electromechanical coupling times in LV basal segments before CABG.
Results: Twenty (25.3%) patients died within 30 days after CABG. Survivors (n=59) showed larger extent of viable myocardium (6.9±3.6 viable segments vs. 3.4±3.3 viable segments, p<0.001) and smaller LV dyssynchrony (75±55 ms vs. 179±83 ms, p<0.001) than nonsurvivors. The presence of LV dyssynchrony > = 105 ms and <5 dysfunctional but viable segments predicted independently in-hospital mortality (p<0.001). Presence of myocardial viability stabilized mortality at the level predicted by EuroSCORE (Table 1⇓). Presence of viability with concomitant absence of dyssynchrony halved the predicted mortality. In contrast, absence of viability tripled the risk of perioperative death as compared to value estimated by EuroSCORE. All but two patients (94.1%) with viable myocardium and without dyssynchrony (VIAB -DYS) survived operation as compared to only 12 (52.2%) patients with nonviable myocardium and severe dyssynchrony (NVIAB +DYS).
Conclusion: In high-risk patients with ischemic cardiomyopathy undergoing CABG, EuroSCORE provides accurate estimate of perioperative mortality only in patients with viable myocardium. Heart surgery should be avoided in patients with high EuroSCORE and nonviable myocardium. Table 1⇓. Myocardial viability, LV dyssynchrony versus EuroSCORE to predict perioperative mortality