title: Value of prolonged QRS duration as a predictor of low cardiac output syndrome in patients with impaired left ventricular systolic function who undergo isolated coronary artery bypass grafting.
abstract: This study determined whether prolonged QRS duration (QRSd; > or =120 ms) is an independent predictor of low cardiac output syndrome (LCOS) in patients with low left ventricular (LV) ejection fraction (EF) who underwent isolated coronary artery bypass grafting (CABG). Abnormal LV systolic function places patients at greater risk for developing LCOS after isolated CABG. In patients with this form of ventricular function impairment, prolonged QRSd is associated with adverse hemodynamic effects. Clinical, operative, and outcome data from 190 consecutive patients with LVEF <50% who underwent isolated CABG (mean 62 +/- 9 years of age) were retrospectively analyzed. For all patients, preoperative QRSd was determined. LCOS was the primary outcome investigated. Fifty-seven patients (30%) developed LCOS. Compared with the subgroup without LCOS, the subgroup with this syndrome had significantly larger proportions of patients with LVEF <30% and prolonged QRSd. In addition, the group that developed LCOS had a longer mean QRSd (117 +/- 25 vs 102 +/- 17 ms, respectively, p = 0.00003) and a significantly higher frequency of adverse postoperative outcomes. Hospital stay was significantly longer in the subgroup with LCOS than in the subgroup without. Multivariate logistic regression analysis identified prolonged QRSd as the most significant predictor of LCOS. LVEF <30%, diuretic therapy, and preoperative risk score (European System for Cardiac Operative Risk Evaluation) were also identified as independent predictors of LCOS. In conclusion, in patients with impaired LV systolic function, prolonged QRSd is a highly significant predictor of LCOS development after isolated CABG.
authors.affiliation: Department of Cardiology, Başkent University Adana Teaching and Medical Research Center, Adana, Turkey. tacil@lycos.com
authors.forename: Tayfun
authors.initials: T
authors.lastname: Açil
authors.forename: Riza
authors.initials: R
authors.lastname: Türköz
authors.forename: Meltem
authors.initials: M
authors.lastname: Açil
authors.forename: Alpay Turan
authors.initials: AT
authors.lastname: Sezgin
authors.forename: Mehmet
authors.initials: M
authors.lastname: Baltali
authors.forename: Oner
authors.initials: O
authors.lastname: Gülcan
authors.forename: Bülent
authors.initials: B
authors.lastname: Ozin
authors.forename: Haldun
authors.initials: H
authors.lastname: Müderrisoğlu
mesh_terms: D002303:Cardiac Output, Low / Q000209:etiology* / Q000503:physiopathology*; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000503:physiopathology / Q000601:surgery*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013577:Syndrome; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology*