Abstract 12144: Impact of Left Ventricular Diastolic Dysfunction on Long-Term Outcomes Following Coronary Artery Bypass Grafting: 5-Year Outcomes of the CREDO-Kyoto CABG Registry Cohort-2
Background: Left ventricular (LV) systolic dysfunction (heart failure [HF] with low ejection fraction [EF]) is regarded as an independent risk factor for poor outcomes after coronary artery bypass grafting (CABG). However, the impact of LV diastolic dysfunction (HF with normal LVEF) still has been unclear.
Methods and Results: We identified 1877 patients who received isolated CABG among 15,939 patients undergoing first coronary revascularization enrolled in the CREDO-Kyoto Registry Cohort-2. Among them, 1489 patients had normal LV function (LVEF>50% without a history of HF; Normal group), 236 had LV systolic dysfunction (LVEF≤50% with HF; LVSD group), and 152 had LV diastolic dysfunction (LVEF>50% with HF; LVDD group). Preoperative LVEF in the LVSD group (36±9%) was markedly lower than the Normal (62±12%) and the LVDD groups (61±7%) (p<0.0001). [Table/Figure] In-hospital mortality in the LVDD group was equivalent to the Normal group (1.3% vs. 1.0%, p=0.72). However, cumulative all-cause mortality at 5-year in the LVDD group (32.1%) was higher than the Normal (13.7%) or the LVSD group (27.1%) (p<0.0001). Multivariate analysis showed that the risk of all-cause death in the LVDD group was higher than the Normal group (hazard ratio [95% confidence interval]: 1.43 [1.03-1.98], p=0.03). In addition, the risk of all-cause death in the LVDD group was equivalent to the LVSD group (0.89 [0.62-1.29], p=0.54). Furthermore, the risks of cardiac death and sudden death in the LVDD group were markedly higher than the Normal group (2.07 [1.27-3.36], p<0.01 and 3.60 [1.55-8.36], p<0.01), and the risks of those endpoints were not different between the LVSD and the LVDD groups.
Conclusions: In spite of low in-hospital mortality after CABG in patients with LV diastolic dysfunction, they were associated with higher risks of long-term death and cardiovascular events. Patients with LV diastolic dysfunction, as well as LV systolic dysfunction, should be carefully operated and followed-up.
Author Disclosures: A. Marui: None. N. Nishiwaki: None. T. Komiya: None. M. Hanyu: None. S. Tanaka: None. T. Kimura: Research Grant; Significant; Pharmaceuticals and Medical Devices Agency (PMDA) in Japan. R. Sakata: None.
- © 2014 by American Heart Association, Inc.