title: Cardiac Magnetic Resonance Imaging Predictors of Short-Term Outcomes after High Risk Coronary Surgery.
abstract: BACKGROUND
  The euroSCORE II is a widely used pre-coronary artery bypass graft surgery (CAGS) risk score, but its predictive power lacks the specificity to predict outcomes in high-risk patients (<LVEF 40%) due to changes in cardiac surgery case mix, revascularisation techniques and related outcomes in recent years. We investigated the utility of Cardiac Magnetic Resonance Imaging (CMRI) in predicting immediate and six-week outcomes after CAGS.
  
  
  METHODS
  Fifty-two consecutive patients with high euroSCORE II (>16) and left ventricular (LV) dysfunction (<40%) based on 2D-echocardiography who underwent CAGS and in whom CMRI (1.5T) was performed preoperatively were retrospectively studied. Cardiac magnetic resonance imaging parameters were assessed in patients who either had complications immediately post-surgery (n=35), six weeks post-surgery (n=20) or were uncomplicated.
  
  
  RESULTS
  The average age of patients recruited was 69±5 years with high euroSCORE II (22±4) and low 2D-echocardiography LV ejection fraction (38%±2%). Cardiac magnetic resonance imaging results demonstrated that those with immediate complications had higher LV scar/infarct burden as a proportion of LV mass (17±3% vs 10±3%; p=0.04) with lower circumferential relaxation index (2.5±0.46 vs 2.8±0.56; p=0.05) compared to those with no complications. Early mortality from surgery was 17% (n=9) and was associated with lower RV stroke volume (55±12 vs 68±18; p=0.03) and higher LV infarct scar/burden (18±2% vs 10±2%, p=0.04). Cardiac magnetic resonance imaging showed patients with complications at six weeks post-surgery had higher LV scar/infarct burden (14.5±2% vs 6.8±2%, p=0.03) compared to those without complications.
  
  
  CONCLUSIONS
  Cardiac magnetic resonance imaging preoperative LV and RV parameters are valuable in assessing the likelihood of successful outcomes from CAGS in high-risk patients with LV dysfunction.
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
authors.forename: Mohammed J
authors.initials: MJ
authors.lastname: Sheriff
authors.affiliation: The Baird Institute, Sydney, NSW, Australia; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
authors.forename: Omar
authors.initials: O
authors.lastname: Mouline
authors.affiliation: Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Translational Imaging Laboratory, Heart Research Institute & Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia.
authors.forename: Chijen
authors.initials: C
authors.lastname: Hsu
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Sydney Translational Imaging Laboratory, Heart Research Institute & Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia; Department of Radiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
authors.forename: Stuart M
authors.initials: SM
authors.lastname: Grieve
authors.affiliation: The Baird Institute, Sydney, NSW, Australia; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Wilson
authors.affiliation: The Baird Institute, Sydney, NSW, Australia; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia.
authors.forename: Paul G
authors.initials: PG
authors.lastname: Bannon
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, NSW, Australia; The Baird Institute, Sydney, NSW, Australia; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Vallely
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia. Electronic address: raj.puranik@cmrs.org.au.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Puranik
mesh_terms: D000368:Aged; D006332:Cardiomegaly / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D001026:Coronary Artery Bypass; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D011300:Preoperative Care; D012189:Retrospective Studies; D013318:Stroke Volume
keywords: CMRI; Cardiac magnetic resonance imaging; Coronary Artery Bypass Graft; EuroSCORE II