Non-Invasive Risk Assessment and Prediction of Mortality in Patients Undergoing Coronary Artery Bypass Graft Surgery
<b>Objectives:</b> Heart rate turbulence (HRT) and T-wave alternans (TWA), non-invasive markers of cardiac autonomic dysfunction, and ventricular repolarization abnormality, reportedly, predict the risk of cardiovascular death after myocardial infarction. We investigated whether pre-oper...
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| Format: | Article |
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MDPI AG
2023-08-01
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| Series: | Journal of Cardiovascular Development and Disease |
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| Online Access: | https://www.mdpi.com/2308-3425/10/9/365 |
| _version_ | 1797579534864744448 |
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| author | Ju-Youn Kim Young-Jun Park Kyoung-Min Park Young-Keun On June-Soo Kim Seung-Jung Park Young-Tak Lee |
| author_facet | Ju-Youn Kim Young-Jun Park Kyoung-Min Park Young-Keun On June-Soo Kim Seung-Jung Park Young-Tak Lee |
| author_sort | Ju-Youn Kim |
| collection | DOAJ |
| description | <b>Objectives:</b> Heart rate turbulence (HRT) and T-wave alternans (TWA), non-invasive markers of cardiac autonomic dysfunction, and ventricular repolarization abnormality, reportedly, predict the risk of cardiovascular death after myocardial infarction. We investigated whether pre-operative assessment of HRT and/or TWA could predict long-term mortality following coronary artery bypass graft (CABG) surgery. <b>Methods:</b> From May 2010 to December 2017, patients undergoing elective CABG and receiving 24 h ambulatory electrocardiogram monitoring 1 to 5 days prior to CABG surgery were prospectively enrolled. Pre-operative HRT and TWA were measured using a 24 h ambulatory electrocardiogram. The relative risk of cardiac or overall death was assessed according to abnormalities of HRT, TWA, or left ventricular ejection fraction (LV EF). <b>Results:</b> During the mean follow-up period of 4.6 <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><mo>±</mo></mrow></semantics></math></inline-formula> 3.9 years, 40 adjudicated overall (5.9%/yr) and 5 cardiac deaths (0.9%/yr) occurred in 146 enrolled patients (64.9 <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><mo>±</mo></mrow></semantics></math></inline-formula> 9.3 years; 108 males). Patients with abnormal HRT exhibited significantly higher relative risks of cardiac death (adjusted hazard ratio [HR] 24.9, 95% confidence interval [CI] 1.46–427) and all-cause death (adjusted HR 5.77, 95% CI 2.34–14.2) compared to those with normal HRT. Moreover, abnormal HRT plus abnormal TWA and LV EF < 50% was associated with a greater elevation in cardiac and overall mortality risk. The predictive role of abnormal HRT with/without abnormal TWA for all-cause death was likely more prominent in patients with mildly reduced (35 to 50%) or preserved (≥50%) LV EF. Abnormal HRT plus abnormal TWA and LV EF < 50% showed high negative predictive value in cardiac and overall mortality risk. <b>Conclusions:</b> Assessment of pre-operative HRT and/or TWA predicted mortality risk in patients undergoing elective CABG. Combined analysis of HRT, TWA, and LVEF enhanced the prognostic power. In particular, the predictive value of HRT was enhanced in patients with preserved or mid-range LV EF. |
| first_indexed | 2024-03-10T22:38:29Z |
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| institution | Directory Open Access Journal |
| issn | 2308-3425 |
| language | English |
| last_indexed | 2024-03-10T22:38:29Z |
| publishDate | 2023-08-01 |
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| series | Journal of Cardiovascular Development and Disease |
| spelling | doaj.art-ace8b3b0441746049e263fba5c98fb572023-11-19T11:16:24ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252023-08-0110936510.3390/jcdd10090365Non-Invasive Risk Assessment and Prediction of Mortality in Patients Undergoing Coronary Artery Bypass Graft SurgeryJu-Youn Kim0Young-Jun Park1Kyoung-Min Park2Young-Keun On3June-Soo Kim4Seung-Jung Park5Young-Tak Lee6Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of KoreaDivision of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju 24715, Republic of KoreaDivision of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of KoreaDivision of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of KoreaDivision of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of KoreaDivision of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of KoreaDepartment of Thoracic and Cardiovascular Surgery, Incheon Sejong Hospital, Incheon 21080, Republic of Korea<b>Objectives:</b> Heart rate turbulence (HRT) and T-wave alternans (TWA), non-invasive markers of cardiac autonomic dysfunction, and ventricular repolarization abnormality, reportedly, predict the risk of cardiovascular death after myocardial infarction. We investigated whether pre-operative assessment of HRT and/or TWA could predict long-term mortality following coronary artery bypass graft (CABG) surgery. <b>Methods:</b> From May 2010 to December 2017, patients undergoing elective CABG and receiving 24 h ambulatory electrocardiogram monitoring 1 to 5 days prior to CABG surgery were prospectively enrolled. Pre-operative HRT and TWA were measured using a 24 h ambulatory electrocardiogram. The relative risk of cardiac or overall death was assessed according to abnormalities of HRT, TWA, or left ventricular ejection fraction (LV EF). <b>Results:</b> During the mean follow-up period of 4.6 <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><mo>±</mo></mrow></semantics></math></inline-formula> 3.9 years, 40 adjudicated overall (5.9%/yr) and 5 cardiac deaths (0.9%/yr) occurred in 146 enrolled patients (64.9 <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><mo>±</mo></mrow></semantics></math></inline-formula> 9.3 years; 108 males). Patients with abnormal HRT exhibited significantly higher relative risks of cardiac death (adjusted hazard ratio [HR] 24.9, 95% confidence interval [CI] 1.46–427) and all-cause death (adjusted HR 5.77, 95% CI 2.34–14.2) compared to those with normal HRT. Moreover, abnormal HRT plus abnormal TWA and LV EF < 50% was associated with a greater elevation in cardiac and overall mortality risk. The predictive role of abnormal HRT with/without abnormal TWA for all-cause death was likely more prominent in patients with mildly reduced (35 to 50%) or preserved (≥50%) LV EF. Abnormal HRT plus abnormal TWA and LV EF < 50% showed high negative predictive value in cardiac and overall mortality risk. <b>Conclusions:</b> Assessment of pre-operative HRT and/or TWA predicted mortality risk in patients undergoing elective CABG. Combined analysis of HRT, TWA, and LVEF enhanced the prognostic power. In particular, the predictive value of HRT was enhanced in patients with preserved or mid-range LV EF.https://www.mdpi.com/2308-3425/10/9/365coronary artery bypass graftheart rate turbulenceT-wave alternansdeathleft ventricular systolic function |
| spellingShingle | Ju-Youn Kim Young-Jun Park Kyoung-Min Park Young-Keun On June-Soo Kim Seung-Jung Park Young-Tak Lee Non-Invasive Risk Assessment and Prediction of Mortality in Patients Undergoing Coronary Artery Bypass Graft Surgery Journal of Cardiovascular Development and Disease coronary artery bypass graft heart rate turbulence T-wave alternans death left ventricular systolic function |
| title | Non-Invasive Risk Assessment and Prediction of Mortality in Patients Undergoing Coronary Artery Bypass Graft Surgery |
| title_full | Non-Invasive Risk Assessment and Prediction of Mortality in Patients Undergoing Coronary Artery Bypass Graft Surgery |
| title_fullStr | Non-Invasive Risk Assessment and Prediction of Mortality in Patients Undergoing Coronary Artery Bypass Graft Surgery |
| title_full_unstemmed | Non-Invasive Risk Assessment and Prediction of Mortality in Patients Undergoing Coronary Artery Bypass Graft Surgery |
| title_short | Non-Invasive Risk Assessment and Prediction of Mortality in Patients Undergoing Coronary Artery Bypass Graft Surgery |
| title_sort | non invasive risk assessment and prediction of mortality in patients undergoing coronary artery bypass graft surgery |
| topic | coronary artery bypass graft heart rate turbulence T-wave alternans death left ventricular systolic function |
| url | https://www.mdpi.com/2308-3425/10/9/365 |
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