Multivariate And Predictor Analysis Of Cardiac Function Improvement After Coronary Artery Bypass Grafting For Ischemic Left Heart Failure

Objective:The objective was to research the affecting factors and predictors of cardiac function improvement with ischemic left cardiac dysfunction after coronary artery bypass transplantation,in order to provide reference for clinical treatment.Methods:In this study,43 patients with ischemic left ventricular dysfunction who underwent simple CABG surgery in our hospital from December 2016 to May 2020 were retrospectively included.Individual characteristics of the patients,various relevant clinical data before and after surgery,preoperative 13N-NH3·H2O/18F-FDG PET/CT image data and postoperative review of 13N-NH3·H2O/18F-FDG PET/CT were collected.According to postoperative LVEF and preoperative LVEF,patients were segmented into groups:LVEF≥5%was divided into LVEF improved group;LVEF<5%was LVEF unimproved group;To analyze the difference of related baseline indicators between the improvement group and the non-improvement group.Multivariate logistic regression was used to analyze the correlation between related indicators and LVEF improvement.By making receiver operating characteristic curve(ROC),the optimal bound value of LVEF improvement and LVEF failure after coronary artery bypass grafts was obtained by using Youden index method.Results:1.A total of 43 patients with ischemic left ventricular insufficiency were reexamined by PET/CT myocardial perfusion imaging 3-41 months after CABG alone.Among them,29 patients had improved LVEF,while 14 patients had not.2.There were significant differences between the LVEF improved group and the LVEF unimproved group in preoperative number of hibernating myocardium,preoperative LVEF,preoperative triglyceride level,preoperative red blood cell count,preoperative systolic blood pressure,bypass count,anastomotic number of ascending aorta,postoperative hibernating myocardium recovery index,postoperative ESV reduction value,and postoperative ESV reduction rate(P<0.05).Group compared with the group did not improve,improve the preoperative hibernating myocardium more,preoperative LVEF lower,preoperative lower triglycerides,less preoperative red blood cell count,preoperative systolic blood pressure is higher,the bridge to count more,ascending aorta anastomotic several more,better recovery of hibernating myocardium,postoperative ESV reduce value larger,postoperative ESV decrease rate is bigger.Between the two groups before operation,there was no significant difference in the number of normal myocardium(P>0.05).3.Multivariate logistic regression analysis showed that hibernating myocardium was an independent predictor of postoperative LVEF improvement(OR=1.403,P=0.041).The area under the ROC curve was 0.834 and 95%CI was 0.714-0.953.The threshold value of hibernating myocardium calculated by yoden index method was 13.5%,the sensitivity was 55.2%,and the specificity was 100%.Conclusion:1.After CABG in patients,the number of hibernating myocardium was an independent predictor of LVEF improvement,2.The percentage of hibernating myocardium in the left ventricle ≥13.5%can accurately predict the improvement of LVEF with ischemic left ventricular dysfunction after CABG.3.The number of bypass grafts and anastomosis of ascending aorta in the improved LVEF group was more than that in the unimproved LVEF group.4.Compared with the unimproved LVEF group,the improved LVEF group had a better recovery of the hibernating myocardium,a greater decrease in postoperative ESV,and a higher decrease rate of postoperative ESV.