Cardiac imaging improves risk stratification in high-risk patients undergoing surgical revascularization

Alessia Gimelli, Antonio L'Abbate, Mattia Glauber, Andrea Ripoli, Assuero Giorgetti, Paolo Marzullo

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

OBJECTIVE: In patients with ischaemic left ventricular dysfunction, multivessel disease and dominance of necrotic myocardium, perioperative mortality due to coronary artery bypass grafting is still a rather unclear issue. The aim of this study was to analyse the impact of different imaging variables in predicting perioperative mortality. METHODS: We selected a group of 259 patients who had preoperatively been defined as 'high-risk patients' and who showed a mostly necrotic myocardium as detected by thallium-201 myocardial scintigraphy. RESULTS: Mean ejection fraction was 0.26 ± 0.07. In a 16-segment model, the mean number of scintigraphic necrotic myocardial segments was 5.07 ± 1.09, echocardiographic end-diastolic diameter was 29.41 ± 2.38 mm/m and wall motion score index was 2.29 ± 0.19. Perioperative mortality increased along with the increase in the number of necrotic segments: 5/105 (5%), 4/63 (6%), 8/52 (15%) and 8/39 (20%) patients with four, five, six and seven necrotic segments, respectively. The analysis of additional variables in survived vs. deceased patients demonstrated a significant difference in echocardiographic end-diastolic diameter (27 ± 8 vs. 31.9 ± 1.9 mm/m, P <0.001) and in wall motion score index (2.2 ± 0.1 vs. 2.4 ± 0.2, P <0.001). CONCLUSIONS: In high-risk patients, the extension of scintigraphic myocardial scar has a significant impact on perioperative mortality. For similar values of ejection fraction at rest, additional imaging variables, such as echocardiographic end-diastolic diameter and wall motion score index, may contribute to select those patients in whom mortality may exceed 15%.

Original languageEnglish
Pages (from-to)51-56
Number of pages6
JournalJournal of Cardiovascular Medicine
Volume7
Issue number1
DOIs
Publication statusPublished - 2006

Fingerprint

Mortality
Myocardium
Myocardial Perfusion Imaging
Thallium
Left Ventricular Dysfunction
Coronary Artery Bypass
Cicatrix

Keywords

  • Cardiac surgical procedures
  • Myocardial revascularization
  • Nuclear cardiology

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Cardiac imaging improves risk stratification in high-risk patients undergoing surgical revascularization. / Gimelli, Alessia; L'Abbate, Antonio; Glauber, Mattia; Ripoli, Andrea; Giorgetti, Assuero; Marzullo, Paolo.

In: Journal of Cardiovascular Medicine, Vol. 7, No. 1, 2006, p. 51-56.

Research output: Contribution to journalArticle

Gimelli, Alessia ; L'Abbate, Antonio ; Glauber, Mattia ; Ripoli, Andrea ; Giorgetti, Assuero ; Marzullo, Paolo. / Cardiac imaging improves risk stratification in high-risk patients undergoing surgical revascularization. In: Journal of Cardiovascular Medicine. 2006 ; Vol. 7, No. 1. pp. 51-56.
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abstract = "OBJECTIVE: In patients with ischaemic left ventricular dysfunction, multivessel disease and dominance of necrotic myocardium, perioperative mortality due to coronary artery bypass grafting is still a rather unclear issue. The aim of this study was to analyse the impact of different imaging variables in predicting perioperative mortality. METHODS: We selected a group of 259 patients who had preoperatively been defined as 'high-risk patients' and who showed a mostly necrotic myocardium as detected by thallium-201 myocardial scintigraphy. RESULTS: Mean ejection fraction was 0.26 ± 0.07. In a 16-segment model, the mean number of scintigraphic necrotic myocardial segments was 5.07 ± 1.09, echocardiographic end-diastolic diameter was 29.41 ± 2.38 mm/m and wall motion score index was 2.29 ± 0.19. Perioperative mortality increased along with the increase in the number of necrotic segments: 5/105 (5{\%}), 4/63 (6{\%}), 8/52 (15{\%}) and 8/39 (20{\%}) patients with four, five, six and seven necrotic segments, respectively. The analysis of additional variables in survived vs. deceased patients demonstrated a significant difference in echocardiographic end-diastolic diameter (27 ± 8 vs. 31.9 ± 1.9 mm/m, P <0.001) and in wall motion score index (2.2 ± 0.1 vs. 2.4 ± 0.2, P <0.001). CONCLUSIONS: In high-risk patients, the extension of scintigraphic myocardial scar has a significant impact on perioperative mortality. For similar values of ejection fraction at rest, additional imaging variables, such as echocardiographic end-diastolic diameter and wall motion score index, may contribute to select those patients in whom mortality may exceed 15{\%}.",
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AB - OBJECTIVE: In patients with ischaemic left ventricular dysfunction, multivessel disease and dominance of necrotic myocardium, perioperative mortality due to coronary artery bypass grafting is still a rather unclear issue. The aim of this study was to analyse the impact of different imaging variables in predicting perioperative mortality. METHODS: We selected a group of 259 patients who had preoperatively been defined as 'high-risk patients' and who showed a mostly necrotic myocardium as detected by thallium-201 myocardial scintigraphy. RESULTS: Mean ejection fraction was 0.26 ± 0.07. In a 16-segment model, the mean number of scintigraphic necrotic myocardial segments was 5.07 ± 1.09, echocardiographic end-diastolic diameter was 29.41 ± 2.38 mm/m and wall motion score index was 2.29 ± 0.19. Perioperative mortality increased along with the increase in the number of necrotic segments: 5/105 (5%), 4/63 (6%), 8/52 (15%) and 8/39 (20%) patients with four, five, six and seven necrotic segments, respectively. The analysis of additional variables in survived vs. deceased patients demonstrated a significant difference in echocardiographic end-diastolic diameter (27 ± 8 vs. 31.9 ± 1.9 mm/m, P <0.001) and in wall motion score index (2.2 ± 0.1 vs. 2.4 ± 0.2, P <0.001). CONCLUSIONS: In high-risk patients, the extension of scintigraphic myocardial scar has a significant impact on perioperative mortality. For similar values of ejection fraction at rest, additional imaging variables, such as echocardiographic end-diastolic diameter and wall motion score index, may contribute to select those patients in whom mortality may exceed 15%.

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