Prognostic determinants of left ventricular ejection fraction improvement 12 months after myocardial revascularization

Background

Recovery of left ventricular function after myocardial revascularization varies widely among patients with ischemic heart failure (HF), but the determinants of left ventricular ejection fraction (LVEF) improvement remain poorly understood.

Study aim: To assess the proportion of patients with LVEF improvement over 12 months after myocardial revascularization and to identify predictors of this outcome in ischemic HF patients.

Methods

A total of 275 patients with ischemic HF undergoing myocardial revascularization were enrolled, including 54.5% subjects who underwent coronary artery bypass grafting and 45.5% of patients treated with percutaneous coronary intervention. The cohort had a mean age of 63.12±0.54 years, comprising 217 men (78.9%) and 58 women (21.1%). Clinical evaluation was performed at baseline and at 12 months post-myocardial revascularization, incorporating laboratory tests and transthoracic echocardiography. LVEF improvement was defined as an increase in LVEF of ≥10% during follow-up in patients who had a LVEF ≤40% at baseline, resulting in a LVEF >40% at the end of the study. Statistical analyses involved the Student’s t-test, Pearson chi-square test, calculation of odds ratio with 95% confidence interval.

Results

At baseline, patients were stratified by HF phenotype as follows: 64.0% had HF with preserved LVEF, 16.0% had HF with mildly reduced LVEF, and 20.0% had HF with reduced LVEF. The mean LVEF at baseline for the cohort was 50.53±0.58%, showing a significant improvement during follow-up, with an increase of +1.76±0.43% (p<0.001). Among all patients with reduced LVEF at baseline, improvement was observed in 23.9% of cases by the end of the study. The univariate analysis revealed the following parameters as relevant for this patient category: older age (66.0±1.40 years vs 61.41±1.15 years, p<0.05), increased left atrial diameter (46.55±1.11 mm vs 43.69±0.66 mm, p<0.05), reduced right ventricular myocardial performance index (0,38±0,06 vs 0,61±0,06, p<0,05), elevated tricuspid regurgitation velocity (2.96±0.07 m/s vs 2.76±0.03 m/s, p<0.05), enlarged pulmonary artery diameter (28.48±0.64 mm vs 26.74±0.34 mm, p<0.05). Multivariate statistical analysis of these variables identified the prognostic determinants for LVEF improvement at 12 months after myocardial revascularization: age (OR=0.942, 95% CI=0.889–0.998, p<0.05), left atrium diameter (OR=0.899, 95% CI=0.812–0.997, p<0.05), tricuspid regurgitation velocity (OR=0.147, 95% CI=0.030–0.704, p<0.05), pulmonary artery diameter (OR=0.830, 95% CI=0.708–0.973, p<0.05).

Conclusion

At 12 months after myocardial revascularization, LVEF improvement occurred in 23.9% of ischemic HF patients, with age, tricuspid regurgitation velocity, pulmonary artery and left atrial diameters identified as significant predictors of this outcome.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.