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Impact of long-axis function on cardiac surgical outcomes in patients with radiation-associated heart disease

Chirakarnjanakorn, Srisakul, MD ; Popović, Zoran B., MD, PhD ; Wu, Willis, MD ; Masri, Ahmad, MD ; Smedira, Nicholas G., MD ; Lytle, Bruce W., MD ; Griffin, Brian P., MD ; Desai, Milind Y., MD

The Journal of thoracic and cardiovascular surgery, 2015-06, Vol.149 (6), p.1643-1651.e2 [Revista revisada por pares]

United States: Elsevier Inc

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Impact of long-axis function on cardiac surgical outcomes in patients with radiation-associated heart disease
Autor: Chirakarnjanakorn, Srisakul, MD ; Popović, Zoran B., MD, PhD ; Wu, Willis, MD ; Masri, Ahmad, MD ; Smedira, Nicholas G., MD ; Lytle, Bruce W., MD ; Griffin, Brian P., MD ; Desai, Milind Y., MD
Materias: Aged ; Cardiac Surgical Procedures - adverse effects ; Cardiac Surgical Procedures - mortality ; Cardiothoracic Surgery ; Chi-Square Distribution ; echocardiography ; Female ; Heart Diseases - diagnosis ; Heart Diseases - etiology ; Heart Diseases - mortality ; Heart Diseases - physiopathology ; Heart Diseases - surgery ; Humans ; Kaplan-Meier Estimate ; Linear Models ; Male ; Middle Aged ; Multivariate Analysis ; Myocardial Contraction ; Odds Ratio ; outcomes ; Predictive Value of Tests ; Proportional Hazards Models ; Radiation Injuries - diagnosis ; Radiation Injuries - etiology ; Radiation Injuries - mortality ; Radiation Injuries - physiopathology ; Radiation Injuries - surgery ; radiation-associated cardiac disease ; Radiotherapy - adverse effects ; Retrospective Studies ; Risk Assessment ; Risk Factors ; strain ; Stress, Mechanical ; Stroke Volume ; Thoracic Neoplasms - mortality ; Thoracic Neoplasms - radiotherapy ; Time Factors ; Treatment Outcome ; Ventricular Function, Left
Es parte de: The Journal of thoracic and cardiovascular surgery, 2015-06, Vol.149 (6), p.1643-1651.e2
Notas: ObjectType-Article-2
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Descripción: Abstract Background Malignancy-associated thoracic radiation leads to radiation-associated cardiac disease (RACD) that often necessitates cardiac surgery. Myocardial dysfunction is common in patients with RACD. We sought to determine the predictive value of global left ventricular ejection fraction and long-axis function left ventricular global longitudinal strain (LV-GLS) in such patients. Methods We studied 163 patients (age, 63 ± 14 years; 74% women) who had RACD and underwent cardiac surgery (20% had reoperations) between 2000 and 2003. In addition to standard echocardiography, LV-GLS (%) was derived from the average of 18 segments in 3 apical views of the left ventricle, using velocity vector imaging. Standard clinical and demographic parameters were recorded. All-cause mortality was recorded. Results The mean duration between cardiac surgery and the last chest radiation was 18 ± 12 years. The median European System for Cardiac Operative Risk Evaluation (EuroSCORE) was 8, and 88 patients died over 6.6 ± 4 years. A total of 52% of patients had ≥II+ mitral regurgitation; 23% of patients had severe aortic stenosis; and 39% of patients had ≥II+ tricuspid regurgitation. The mean left ventricular ejection fraction was 54% ± 13%, and the mean LV-GLS was −12.9% ± 4%. In a Cox proportional survival analysis, lower LV-GLS was predictive of mortality in univariable analysis (hazard ratio, 1.07 (95% confidence interval, 1.01-1.14); P = .006); however, after adjustment for other variables, the association became nonsignificant. In patients with a EuroSCORE <median, abnormal LV-GLS (<−14.5%) was associated with significantly higher mortality (48%), compared with those with normal LV-GLS (32%). Conclusions In patients who have RACD and undergo cardiac surgery, LV-GLS does not sufficiently discriminate and is not independently predictive of long-term outcomes. However, in patients with a low EuroSCORE, abnormal LV-GLS was associated with higher mortality, compared with those with normal LV-GLS.
Editor: United States: Elsevier Inc
Idioma: Inglés

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Impact of long-axis function on cardiac surgical outcomes in patients with radiation-associated heart disease

Chirakarnjanakorn, Srisakul, MD ; Popović, Zoran B., MD, PhD ; Wu, Willis, MD ; Masri, Ahmad, MD ; Smedira, Nicholas G., MD ; Lytle, Bruce W., MD ; Griffin, Brian P., MD ; Desai, Milind Y., MD

United States: Elsevier Inc

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