Predictors of survival in patients with ischemic heart disease depending on therapy
Keywordsejection fraction, revascularization, ischemic heart disease, survival predictors.
The aim of the study is to assess the prognostic value of the structural and functional echocardiographic indicators in IHD patients, depending on acute coronary syndrome management (revascularization vs medical therapy), during 60 months.
Materials and methods:The total of 101 IHD patients were examined on the clinical bases of the Internal Medicine Department 2. Prior to the study. The 84 males and 17 females aged 58.6±4.2were split into the experimental group after myocardial revascularization (EG, n = 71) and control group with standard medical therapy (CG, n = 30). In addition to the protocol-prescribed clinical lab tests, during five years, the dynamics of the echocardiographic cardiac parameters has been assessed. The digital data was processed by the Kaplan–Meier estimator; the 60-month cumulative survival rate (%) was estimated and significance of the difference was assessed by Cox's F-test (p<0.05).
Results and discussion.It appeared thatthe 5-year prognosis in IHD patients was unaffected by the dimensions of IVST, LVIDD and LVMMI. In 60 months after the surgery, a significantly better prognosis was observed for certain unfavourable initial conditions: enlarged RV ≥ 2.5 cm (37.5% vs 30.7%, р = 0.008), aortic diameter ≥ 3.0 cm (57.2% vs 34.3%, р = 0.02), enlarged LA ˃ 4.0 cm (43.8% vs 24.7%, р = 0.046). In addition, revascularization was associated with better survival rates for normal LVMM (<250 g; 75.8% vs 49.1%, р=0.05), without the thickening of the LV walls (66.9% vs 30.5%, р=0.047) and without LV systolic dysfunction (87.7% vs 59.9%, р=0.046). An important place among the echocardiographic criteria of unfavourable prognosis belongs to LV systolic dysfunction (EF ≤ 45%). Therefore, the experimental group patients were distributed according to the EF value, following the Ukrainian Association of Cardiology and EU guidelines, i.e. we singled out the so-called grey zone (EF=45-54%), where the patients featuring LV systolic dysfunction and preserved EF belonged. The analysis of the results showed the cumulative event-free survival to be 87.4% for EF ˃ 55%, 14.6% for EF = 45-54% and 42.9% for EF < 45% (р = 0.01). The patients after the myocardial revascularization with EF = 45-54% had a worse prognosis of event-free survival than those with LV systolic dysfunction. In the group of patients who had undergone only the medical therapy, the survival prognosis was significantly worse, which corresponded to a reduced EF (38.3% for EF ˃ 55%, 15.0% for EF = 45-54% and 0% for EF < 45%, pEG-CG = 0.01). A similar EF-based distribution was used in the study of patients with decompensated heart failure (REDINSCOR II, 2017), in which the authors revealed that the grey zone patients featured a higher risk of cardiovascular complications than patients with normal EF values did.
Conclusions.Revascularization contributed to a considerably better 60-month survival prognosis for cases featuring the enlarged right ventricle (≥2.5 cm), enlarged left atrium (˃4.0 cm) and extended aortic root (≥3.0 cm), but with the normal left ventricular myocardial mass (< 250 g) and without ventricular hypertrophy or systolic dysfunction.
Filsoufi F, Jouan J et al. Results and predictors of early and late outcome of coronary artery bypass graft surgery in patients with ejection fraction less than 20 %. Arch. Cardiovasc. Dis. 2008;101(9):547-556.
BaxJJ,Schinkel AFL, Boersma E et al. Extensive left ventricular remodeling does not allow viable myocardium to improve in left ventricular ejection fraction after revascularization and is associated with worse long-term prognosis. Circulation. 2004;110:18–22.
Denesyuk VI, Denesyuk OV, Muzyka NO. Remodelyuvannya livoho shlunochka u khvorykh na stabilʹhu stenokardiyu, uskladnenu sertsevoyu nedostatnistyu, zi znyzhenoyu i zberezhenoyu fraktsiyeyu vykydu [Left ventricular remodeling in patients with angina pectoris, complicated by heart failure, with reduced and preserved ejection fraction]. Lviv Clinical Bulletin. 2016; 2(14)-3(15):8-13.
Lieb W, Gona P, Larson MG et al. The natural history of left ventricular geometry in the community: clinical correlates and prognostic significance of change in LV geometric pattern. JACC Cardiovasc Imaging. 2014;7(9):870-878.
Nadruz W. Myocardial remodeling in hypertension. J.Hum.Hypertens.2015; 29(1):1-6.
Xu L, Huang X, Ma J et al. Value of three-dimensional strain parameters for predicting left ventricular remodeling after ST-elevation myocardial infarction. Int. J. Cardiovasc Imaging. 2017;33(5):663-673.
Sekaran NK, Crowley AL, de Souza FR et al.The Role for Cardiovascular Remodeling in Cardiovascular Outcomes. 2017;19(5):23.
Abdelgawwad IM, Al Hawary AA, Kamal HM et al. Prediction of left ventricular contractile recovery using tissue Doppler strain and strain rate measurements at rest in patients undergoing percutaneous coronary intervention. Int. J. Cardiovasc Imaging. 2017;33(5):643-651.
Merhel TV. Stan skorotlyvoyi zdatnosti livoho shlunochka u khvorykh pislya perenesenoho infarktu miokarda u protsesi vidnovnoho likuvannya [Left Ventricular Contractile State in Patients Undergoing Rehabilitation after Myocardial Infarction]. Halych Medicinal Bulletin. 2015; 22(1):145-147.
Yakovleva LM, Peremot YAO. Chynnyky, shchovplyvayutʹ na viddaleny yprohnoz u khvorykh na ishemichnu khvorobu sertsya, yaki perenesly aortokoronarne shuntuvannya [Factors affecting long-term prognosis in patients with coronary artery disease who underwent coronary artery bypass grafting].Emergency medicine. 2013; 7(54):128-132.
Lang RM, Badano LP, Mor-Avi V et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Journal of the American Society of Echocardiography. 2015; 28(1): 1–39.
Filipyuk AL. Strukturno-funktsionalʹnyy stan sertsya u khvorykh na khronichnu ishemichnu khvorobu sertsya z nadvahoyu ta ozhyrinnyam: predyktory vyzhyvannya [Structural-Functional Cardiac Parameters in Patients with Chronic Ischemic Heart Disease Combined with Overweight and Obesity: Predictors of Survival]. Ukrainian journal of medicine, biology and sports. 2016; 1(1): 99-102.
Zelenchuk OV, Todurov BM. Khirurhichne likuvannya patsiyentiv z ishemichnoyu khvoroboyu sertsya ta vyrazhenoyu systolichnoyu dysfunktsiyeyu livoho shlunochka [Surgical treatment of the ischemic heart disease with severe left ventricular systolic dysfunction].Cardiac surgery and interventional cardiology. 2015;2: 7-15.
Yepanchintseva OA, Zharinov OY, Mikhalyev KO, Todurov BM. Dysfunktsiya livoho shlunochka pered planovoyu khirurhichnoyu revaskulyaryzatsiyeyu. Osoblyvosti "siroyi zony" [Left ventricular dysfunction before planned surgical revascularization. Features of the «grey area»].Ukrainian Cardiology Journal. 2018;1: 29-44.
Gómez-Otero I, Ferrero-Gregori A, Varela RománA et al. Mid-range ejection fraction does not permit risk stratification among patients hospitalized for heart failure. Rev. Esp. Cardiol. (Engl Ed). 2017; 70 (5): 338–346.
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