Influence of wall motion score on mortality after coronary bypass surgery in the CABG-patch trial.
BACKGROUND
It was hypothesized that a wall motion score (WMS) of <or=16% determined by chordal analysis (WMS=% of chords analyzed with normal or hyperkinetic motion) from a right anterior oblique (RAO) left ventriculogram would be a predictor for perioperative (30-day or in-hospital) or long-term mortality in patients from the CABG-Patch Trial.


RESULTS
One hundred and eighty-nine patients from the trial with a LVEF of <or=36% were retrospectively studied. Patients were divided into two groups according to a WMS of <or=16% (n=81) or >16% (n=108), respectively, calculated from a preoperative RAO ventriculogram. There was no difference in EF between the two groups (26.5+/-5.5 vs. 27.8+/-5.3%, respectively). Eight (9.9%) versus three (2.8%) patients died perioperatively in the low versus the high WMS group, respectively. The relative risk for perioperative death in the low WMS group was 3.6 (P<0.04). Kaplan-Meier estimates of cumulative survival did not reveal any statistical difference between the two groups over 4 years (P=0.11). Subgroup analysis revealed that patients with a WMS of <or=16% had a better survival when treated with an ICD at the time of surgery compared to those not treated with an ICD (P=0.046).


CONCLUSIONS
These data indicate that poor LV function, as assessed by a WMS of <or=16%, can identify a subgroup of low EF patients who are at increased risk for perioperative mortality after bypass surgery. Conversely, long-term estimates of survival in patients with WMS <or=16 and >16% were not significantly different, although subgroup analysis revealed that patients with a WMS <or=16% may benefit from implantation of an ICD at the time of surgery.
Jung
Frank
F
Electrophysiology Laboratory, Cardiovascular Division, Department of Internal Medicine, University of Virginia Health Sciences Center, Charlottesville, VA 22908, USA. f.jung@em.uni-frankfurt.de
Herre
John M
JM
Wood
Mark A
MA
O'Donoghue
Susan
S
Cannom
David S
DS
Windle
John R
JR
Hilbel
Thomas
T
Talreja
Deepak R
DR
Parides
Michael K
MK
Bigger
J Thomas
JT
DiMarco
John P
JP
D000368:Aged; D001026:Coronary Artery Bypass / Q000401:mortality*; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery; D015635:Radionuclide Ventriculography / Q000379:methods; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology*