title: [Surgical revascularisation of the heart in patients with chronic ischaemic cardiomyopathy and leftventricular ejection fraction of less than 30%].
abstract: BACKGROUND
  Patients suffering from chronic ischaemic cardiomyopathy and left ventricular ejection fraction (LVEF) lower than 30% represent a difficult and controversial population for surgical treatment.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the effects of surgical treatment on the early and long-term outcome of these patients.
  
  
  METHODS
  The patient population comprised 50 patients with LVEF < 30% (78% male, mean age: 58.3 years, range: 42-75 years) who underwent surgical myocardial revascularisation during the period 1995-2000. Patients with left ventricular aneurysms or mitral valve insufficiency were excluded from the study. The following echocardiography parameters were evaluated as possible prognostic indicators: LVEF, fraction of shortening (FS), left ventricular systolic and diastolic diameters (LVEDD, LVESD) and volumes (LVEDV, LVESV), as well as their indexed values (LVESVI).
  
  
  RESULTS
  Fifteen patients (30%) died during the follow-up, 2/50 intraoperatively (4%). The presence of diabetes mellitus, previous myocardial infarction, main left coronary artery disease, and three-vessel disease, correlated significantly with the surgical outcomes. The patient's age, family history, smoking habits, hypertension, hyperlipidaemia, history of stroke, peripheral vascular disease, and renal failure, did not correlate with the mortality rate. A comparison of preoperative echocardiography parameters between survivors and non-survivors revealed significantly divergent LVEF, LVEDD, LVESD, LVEDV, LVESV, and LVESVI values. Preoperative LVESVI offered the highest predictive value (R = 0.595).
  
  
  CONCLUSIONS
  Diabetes mellitus, history of myocardial infarction, stenosis of the main branch, and three-vessel disease, significantly affected the perioperative and long-term outcome of surgical revascularisation in patients with ischaemic cardiomyopathy and LVEF < 30%. In survivors, LVEF, FS, and systolic and diastolic echocardiography parameters, as well as their indexed values, significantly improved after surgical revascularisation. LVESVI provided the highest predictive value for mortality.
authors.forename: Milos
authors.initials: M
authors.lastname: Velinović
authors.forename: Mladen
authors.initials: M
authors.lastname: Kocica
authors.forename: Mile
authors.initials: M
authors.lastname: Vranes
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Mikić
authors.forename: Vlada
authors.initials: V
authors.lastname: Vukomanović
authors.forename: Lazar
authors.initials: L
authors.lastname: Davidović
authors.forename: Biljana
authors.initials: B
authors.lastname: Obrenović-Krićanski
authors.forename: Slobodan
authors.initials: S
authors.lastname: Cvetkovic
authors.forename: Ljiljana
authors.initials: L
authors.lastname: Soski
authors.forename: Arsen D
authors.initials: AD
authors.lastname: Ristić
mesh_terms: D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*