ANALYSIS OF LEFT VENTRICULAR EJECTION FRACTION AS A PREDICTOR OF DEVELOPMENT OF HEART FAILURE AND RISK STRATIFICATION OF CORONARY BYPASS
DOI:
https://doi.org/10.32689/2663-0672-2024-4-6Keywords:
aortocoronary bypass, left ventricular ejection fraction, dynamics of changes in myocardial contractility, patients of different agesAbstract
In this article, the scientific problem is confined to the study of the values of the left ventricular ejection fraction in patients of different age groups in order to establish the effectiveness of surgical treatment and prevent the progression of heart failure. A detailed review of modern scientific research was carried out to study the available world experience of the influence of the preserved contractile capacity of the myocardium on the development of chronic heart failure. Aim. The purpose of the work is to study the values of the left ventricular ejection fraction in the dynamics of the perioperative period of coronary artery bypass grafting in patients of different age groups with coronary heart disease. Scientific novelty. For the first time, the values of the left ventricular ejection fraction were studied on a large sample of patients with coronary heart disease of different age groups in the dynamics of surgical treatment. Materials and methods. The study included patients with coronary heart disease of different ages (n=3672), the average age of the study participants was 60.6±0.8 years. All patients of this sample underwent coronary bypass surgery on a working heart, and risk stratification was determined for the timeliness of its implementation. Conclusions. Studying the values of the left ventricular ejection fraction in the dynamics of recovery after coronary artery bypass grafting in patients with coronary heart disease of different age groups is important, as it allows to objectively assess the effectiveness of surgical treatment and directly affects life expectancy. It was found that in all age groups, the left ventricular ejection fraction had an increase after coronary artery bypass grafting, which averaged 3.63% and was the highest in middle-aged patients (group #2). It was determined that the left ventricular ejection fraction in the dynamics from hospitalization to the 30-day period after coronary artery bypass grafting was significantly higher in the largest study group – middle-aged patients (р=0.052, χ2=3.77), which directly indicates the timeliness and the effectiveness of its implementation.
References
Argenziano M., Spotnitz H. M., Whang W., Bigger J. T. Jr., Parides M., Rose E. A. Risk stratification for coronary bypass surgery in patients with left ventricular dysfunction: analysis of the coronary artery bypass grafting patch trial database. Circulation. 1999. 100 (19 Suppl). II119-II124. doi:10.1161/01.cir.100.suppl_2.ii-119
Collet J. P., Thiele H., Barbato E., et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation [published correction appears in Eur Heart J. 2021 May 14;42(19):1908. doi: 10.1093/eurheartj/ehaa895] [published correction appears in Eur Heart J. 2021 May 14;42(19):1925. doi: 10.1093/eurheartj/ehab088] [published correction appears in Eur Heart J. 2021 Jun 14;42(23):2298. doi: 10.1093/eurheartj/ehab285] [published correction appears in Eur Heart J. 2024 Feb 1;45(5):404-405. doi: 10.1093/eurheartj/ehad879]. Eur Heart J. 2021;42(14):1289-1367. doi:10.1093/eurheartj/ehaa575
Cuthbert J. J., Pellicori P., Clark A. L. Interatrial shunt devices for heart failure with normal ejection fraction: a technology update. Med Devices (Auckl). 2017 Jun 2. 10. 123–132. doi: 10.2147/MDER.S113105.
Ferrari R., Böhm M., Cleland J. G., et al. Heart failure with preserved ejection fraction: uncertainties and dilemmas. Eur J Heart Fail. 2015. 17 (7). 665–671. doi:10.1002/ejhf.304
Ibanez B., James S., Agewall S., et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018. 39 (2), 119–177. doi: 10.1093/eurheartj/ehx393
Margaryan R., Murzi M. Both sexes should be treated equally: sex difference in patients with ischemic heart failure undergoing surgical revascularization. J Thorac Dis. 2018. 10(Suppl 26). S3153–S3154. doi:10.21037/jtd.2018.08.26
Momin A., Ranjan R., Valencia O., Jacques A., Lim P., Fluck D., et al. Survival and Independent Predictors of Mortality Following Coronary Artery Bypass Graft Surgery in a Single-Unit Practice in the United Kingdom Over 20 Years. Cureus. 2023 May 1. 15 (5), e38413. doi: 10.7759/cureus.38413
Neumann F. J., Sousa-Uva M., Ahlsson A., et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. EuroInterve ntion. 2019. 14 (14), 1435–1534. doi:10.4244/EIJY19M01_01
Nielsen S., Giang K. W., Wallinder A., Rosengren A., Pivodic A., Jeppsson A., et al. Social Factors, Sex, and Mortality Risk After Coronary Artery Bypass Grafting: A Population-Based Cohort Study. J Am Heart Assoc. 2019. 8 (6), e011490. doi: 10.1161/JAHA.118.011490
Patel K., Fonarow G. C., Ekundayo O. J., et al. Beta-blockers in older patients with heart failure and preserved ejection fraction: class, dosage, and outcomes. Int J Cardiol. 2014. 173 (3), 393–401. doi:10.1016/j.ijcard.2014.03.005.
Pellicori P., Cleland J. G. F. Update on management of heart failure with preserved ejection fraction. Curr Opin Cardiol. 2015. 30 (2), 173–178. doi:10.1097/HCO.0000000000000152
Pellicori P., Cleland J.G. Heart failure with preserved ejection fraction. Clin Med (Lond). 2014. 14 Suppl 6. s22–s28. doi:10.7861/clinmedicine.14-6-s22
Piña I. L., Zheng Q., She L., et al. Sex Difference in Patients With Ischemic Heart Failure Undergoing Surgical Revascularization: Results From the STICH Trial (Surgical Treatment for Ischemic Heart Failure). Circulation. 2018. 137 (8). 771–780. doi:10.1161/CIRCULATIONAHA.117.030526
Taggart D. P., Benedetto U., Gerry S., Altman D. G., Gray A.M., Lees B., et al. Bilateral versus Single Internal-Thoracic-Artery Grafts at 10 Years. N Engl J Med. 2019. 380 (5), 437–446. doi: 10.1056/NEJMoa1808783
US National Institutes of Health. ClinicalTrials.gov Restoration of Chronotropic Competence in Heart Failure Patients with Normal Ejection Fraction (RESET) [Accessed February 13, 2017]. Available from: https://clinicaltrials.gov/ct2/show/NCT00670111
