title: Echocardiographic Predictors of Immediate Postoperative Outcomes in Patients With Severe Left Ventricular Systolic Dysfunction Undergoing On-Pump Coronary Artery Bypass Grafting.
abstract: OBJECTIVE
  The postoperative course following on-pump coronary artery bypass grafting (CABG) in patients with severe left ventricular (LV) systolic dysfunction is often unpredictable. Therefore, the aim of this study was to identify predictors of poor postoperative outcome in this subset of patients.
  
  
  METHODS
  Prospective observational study SETTING: Single university hospital PARTICIPANTS: Forty patients with severe LV systolic dysfunction undergoing isolated on-pump CABG INTERVENTIONS: None MEASUREMENTS AND MAIN RESULTS: Comprehensive transesophageal echocardiographic examination was performed to obtain the indices of systolic and diastolic LV function after induction of anesthesia. A poor postoperative outcome was defined as patient death or vasoactive inotropic score≥20 for at least 6 hours and/or requiring intra-aortic balloon counterpulsation and/or mechanical ventilation for≥24 hours. Poor postoperative outcome was observed in 40% (16/40) of patients. Patients with poor postoperative outcomes had a significantly higher systolic dyssynchrony index, septal-lateral delay with a significantly lower global longitudinal strain and isovolumic acceleration, end-diastolic volume, end-systolic volume, and lateral and medial mitral annulus systolic velocity. In a binary logistic regression model, global longitudinal strain (odds ratio, 1.5, confidence interval [CI] 95%, 1.19-1.88, p = 0.001), septal-lateral delay (odds ratio, 1.02, 95% CI, 1.01-1.03; p = 0.001) and systolic dyssychrony index (odds ratio, 1.3, 95% CI, 1.13-1.48; p = 0.000) were found to be predictors of poor postoperative outcome.
  
  
  CONCLUSIONS
  Global longitudinal strain, systolic dyssynchrony index, and septal-lateral delay were reliable and accurate predictors of adverse outcomes in patients with severe LV systolic dysfunction undergoing on-pump CABG.
authors.affiliation: All India Institute of Medical Sciences, New Delhi, India. Electronic address: ajaykjha1212@gmail.com.
authors.forename: Ajay Kumar
authors.initials: AK
authors.lastname: Jha
authors.affiliation: All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Vishwas
authors.initials: V
authors.lastname: Malik
authors.affiliation: All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Parag
authors.initials: P
authors.lastname: Gharde
authors.affiliation: All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Chauhan
authors.affiliation: All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Usha
authors.initials: U
authors.lastname: Kiran
authors.affiliation: All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Milind P
authors.initials: MP
authors.lastname: Hote
mesh_terms: D000368:Aged; D002316:Cardiotonic Agents / Q000008:administration & dosage; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods; D004334:Drug Administration Schedule; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging*
chemical_list: D002316:Cardiotonic Agents
keywords: anesthesia; coronary artery bypass grafting; echocardiography; outcome; predictors