Abstract 17968: Prognostic Value of Right Ventricular Parameters in Patients With Left Ventricular Dysfunction Undergoing Coronary Revascularization. A Longitudinal Study

Background: Data regarding risk stratification in patients with left ventricular (LV) dysfunction undergoing coronary artery bypass grafting (CABG) are scarce. Our objective was to compare echocardiographic, functional and clinical parameters to define independent predictors of long-term outcome. Methods and Results: Comprehensive Doppler echocardiographic data, six-minute walking test (6-MWT) and brain natriuretic peptide (BNP) levels were collected pre-operatively, at discharge and at the follow-up in 137 patients (mean age= 68±6 years,) with LV dysfunction (preoperative EF: 35±06%) undergoing CABG. The population was studied in 2 groups: group1: n=84 with EF ≤ 35 %; group 2: n=53 with EF≥35%). The median follow-up was of 7.2 years (range: 0.2-15.7). Early mortality was 7 %. There was no others significant difference between the 2 groups with regard to demographic and clinical data. There was no difference in BNP level and 6MWT distance between groups and according to the period (i.e. preoperative vs. discharge vs. follow-up). The multivariate Cox proportional Hazard model, after adjustment for cofactors, identified advanced age (HR: 1.12, 95%CI: 1.02-1.22, p=0.01), preoperative peak transmitral gradient (HR= 1.88, 95%CI: 1.72-4.13, p=0.001), preoperative mid RV diameter (HR=0.21, 95%CI: 0.04-1.07, p=0.04), preoperative tricuspid annular plane systolic excursion (TAPSE: HR=1.27, 95%CI: 1.01-1.60, p=0.04) and preoperative BNP levels (HR=1.00, 95%CI: 1.00-1.01, p=0.01) as independent predictors of all-causes of death. Conclusions: Among all the collected variables, preoperative right ventricular mid-diameter and TAPSE are the main echocardiographic independent predictors of all-causes of death in patients with LV dysfunction undergoing CABG. Our study shows the usefulness of right ventricular parameters for predicting the long-term outcome, and indicates that ventricular interactions may contribute to the outcome. Further studies are warranted to elucidate these findings