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J Thorac Cardiovasc Surg 1995;110:944-951
© 1995 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

PREDICTION OF LONG-TERM SURVIVAL BY PREOPERATIVE EXERCISE TESTING IN PATIENTS WITH DEPRESSED EJECTION FRACTION UNDERGOING MYOCARDIAL REVASCULARIZATION

Los Angeles, Calif.

Supported in part by Los Angeles Thoracic and Cardiovascular Foundation.

Received for publication April 28, 1994. Accepted for publication March 10, 1995. Address for reprints: Gregory Louis Kay, MD, 123 South Alvarado St., Los Angeles, CA 90057.

Abstract

Ejection fraction is a major determinant of morbidity and mortality for patients with ischemic heartdisease. Patients with an ejection fraction of 0.40 or less are generally recognized as having apoorer prognosis than those patients with an ejection fraction of 0.50 or better and remain a heterogeneous group. It would be useful if patients with a favorable surgical prognosis could be identified preoperatively. Fifty-five patients who underwent coronary artery bypass grafting and had an ejection fraction less than 0.40 (mean of 0.23 ± 0.07 standard deviation) were studied by catheter measurement of pulmonary arterial pressure and radionuclide left ventriculography. Heartrate, systemic blood pressure, pulmonary artery pressures, cardiac output, and ejection fraction were measured, at rest, after nitroglycerin was given intravenously and with supine bicycle exercise.Forty-seven patients who had follow-up longer than 4 years were divided into two groups according to their life status (alive or dead) 4 years after operation. Measured variables of exercise stress tests and clinical characteristics were entered into factor analysis to obtain a cardiac function factor score for predicting the life status after 4 years. The cardiac function factor score was highly loaded by stroke index (rest, nitroglycerin), cardiac index (exercise), systemic vascular resistance index(exercise), and history of congestive heart failure. The cardiac function factor provided a predictive value superior to that of any individual variable. By dividing the patients into two groups by cardiac function factor score, the actuarial 5-year survival was 72% versus 17% for good and poor prognosis groups, respectively (p < 0.0001). Preoperative exercise stress testing data integrated by factor analysis provide a predictive tool for patients with a low ejection fraction. (J THORAC CARDIOVASC SURG 1995;110:944-51)

This article has been cited by other articles:

				S. Morita, G.-W. Sun, and G. L. Kay Predicting survivorship after coronary artery bypass grafting in patients with low ejection fraction J. Thorac. Cardiovasc. Surg., March 1, 1997; 113(3): 614 - 614. [Full Text]