Right Ventricular Diastolic Dysfunction Before Coronary Artery Bypass Grafting: Impact on 5-Year Follow-Up Outcomes

TL;DR

This study shows that right ventricular diastolic dysfunction before heart surgery increases the risk of poor outcomes over five years.

Contribution

The study identifies right ventricular diastolic dysfunction as a novel predictor of adverse long-term outcomes after CABG.

Findings

Right ventricular diastolic dysfunction was associated with higher rates of MACE after CABG.

Patients without RVDD had better MACE-free survival compared to those with RVDD.

RVDD was a significant independent predictor of adverse outcomes at 5-year follow-up.

Abstract

Background: The aim of this study was to assess the effect of right ventricular diastolic dysfunction on the results of 5-year follow-up of patients after coronary artery bypass grafting (CABG). Methods: Patients were enrolled in this prospective observational study examined before planned CABG from 2017 to 2018. In addition to the baseline preoperative indicators and perioperative data, the initial parameters of the left and right ventricle (RV) systolic and diastolic function were assessed. The long-term results after CABG were assessed after 5 years. The following endpoints were recorded in the remote period: coronary and non-coronary death, non-fatal myocardial infarction (MI), repeat myocardial revascularization. Results: The results of long-term follow-up were assessed in 148 patients, during which time MACE was registered in 43 patients (29.1%). In the group with MACE before CABG, a history of myocardial infarction (p = 0.008), functional class 3 NYHA of chronic heart failure (CHF) (p = 0.013), an increase in the left ventricle size, a decrease in the e′/a′ ratio (p = 0.041), and the presence of the right ventricle diastolic dysfunction (p = 0.037) were more often detected. Kaplan–Meier analysis revealed a better long-term prognosis (MACE-free survival) in the group without RVDD compared to the group with RVDD (p = 0.026). Conclusions: In patients after coronary artery bypass grafting, the development of adverse events was associated with both clinical factors and the presence of right ventricular diastolic dysfunction. Survival analysis revealed a worse prognosis in patients with preoperative RVDD compared with patients without RVDD.

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