O efeito da cirurgia de revascularização miocárdica na função contrátil e sintomas em pacientes com disfunção ventricular esquerda

Abstract

Background: The degree of the left ventricular (LV) dysfunction is an independent risk factor for poor outcomes in patients with chronic coronary syndrome. Coronary artery bypass graft surgery (CABG) is the standard care for the management of ischemic heart failure to improve symptoms and prognosis. However, the predictors of improvement are still uncertain. Objective: To assess the effect of myocardial revascularization on LV function and symptoms in patients with chronic coronary syndrome and reduced left ventricular ejection fraction (LVEF), as well as to identify the improvement predictors. Methods: We retrospectively analyzed 136 consecutive patients with LVEF<50% that underwent CABG between 2013 and 2017 in our institution. During clinical follow-up, echocardiographic LV function was reassessed at the short-term (3.6 months) and long-term (30.8 months), with results being compared to baseline. Results: Mean age was 63.5 ± 9.5 years and 70.6% were male. Mean pre-operative LVEF was 40.9 ± 8.6% and wall motion score index (WMSI) was 1.99 ± 0.36, both improving at short-term to 47.0 ± 12.6% (p<0.001) and 1.80 ± 0.50 (p<0.001), respectively. We observed that 55.7% of the patients presented an improvement of LVEF≥10% and 58.1% on WMSI≥10%. There was no additional incremental on LV function on the long-term assessment. Univariate logistic regression analysis disclosed that cerebrovascular disease (CVD) was the only variable to be predictor of LVEF improvement. Beyond the contractile function response, patients also presented improvement on functional class at the end of the follow up (2.79 ± 0.86 vs. 1.49 ± 0.84, p<0.001). Conclusions: Patients with chronic coronary syndrome and reduced ejection fraction undergoing CABG experienced short-term improvement in both LV contractile function and size, with beneficial long-term response on their functional class