Prognostic implications of preoperative E/e' ratio in patients with off-pump coronary artery surgery.
BACKGROUND
The ratio of early transmitral flow velocity to early diastolic velocity of the mitral annulus (E/e') correlates with left ventricular (LV) filling pressure. In particular, an E/e' ratio more than 15 is an excellent predictor of increased LV filling pressure. The authors evaluated the prognostic implications of preoperative estimated LV filling pressure, assessed by E/e' ratio, in patients undergoing off-pump coronary artery bypass graft surgery.


METHODS
This observational study investigated 1,048 consecutive adults undergoing elective off-pump coronary artery bypass graft surgery. The primary outcome was occurrence of major adverse cardiac events (MACE), defined as a composite of death, myocardial infarction, malignant ventricular arrhythmia, cardiac dysfunction, or need for new revascularization. Logistic regression and survival analyses were performed.


RESULTS
An E/e' ratio more than 15 was independently associated with 30-day MACE (odds ratio 2.4, 95% CI 1.4-3.9, P = 0.001) and 1-yr MACE (hazard ratio 2.1, 95% CI 1.4-3.1, P = 0.001), irrespective of underlying LV ejection fraction. MACE free 1-yr survival rate was significantly decreased in patients with E/e' >15, irrespective of underlying LV ejection fraction.


CONCLUSIONS
Increased LV filling pressure, assessed by E/e' ratio, is an independent predictor of 30-day and 1-yr MACE in patients who undergo elective off-pump coronary artery bypass graft surgery. These findings indicate that measurements of E/e' may assist in preoperative risk stratification of these patients.
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Eun-Ho
EH
Lee
Sung-Cheol
SC
Yun
Ji-Hyun
JH
Chin
Dae-Kee
DK
Choi
Hyo-Jung
HJ
Son
Wook-Chong
WC
Kim
Seong-Soo
SS
Choi
Jun-Gol
JG
Song
Kyung-Don
KD
Hahm
Ji-Yeon
JY
Sim
In-Cheol
IC
Choi
D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects*; D003971:Diastole / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology*; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D013318:Stroke Volume / Q000502:physiology*; D013599:Systole / Q000502:physiology*; D016277:Ventricular Function, Left / Q000502:physiology