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Zhu Z, Li Y, Zhang F, Steiger S, Guo C, Liu N, Lu J, Fan G, Wu W, Wu M, Wang H, Xu D, Chen Y, Zhu J, Meng X, Hou X, Anders HJ, Ye J, Zheng Z, Li C, Zhang H
Prediction of Male Coronary Artery Bypass Grafting Outcomes Using Body Surface Area Weighted Left Ventricular End-diastolic Diameter: Multicenter Retrospective Cohort Study
Body Surface Area Weighted Left Ventricular End-diastolic Diameter More Accurately Predicts Male CABG Outcomes: A Muti-center Cohort Study
Zhihui Zhu;
Yuehuan Li;
Fan Zhang;
Stefanie Steiger;
Cheng Guo;
Nan Liu;
Jiakai Lu;
Guangpu Fan;
Wenbo Wu;
Mingying Wu;
Huaibin Wang;
Dong Xu;
Yu Chen;
Junming Zhu;
Xu Meng;
Xiaotong Hou;
Hans-Joachim Anders;
Jian Ye;
Zhe Zheng;
Chenyu Li;
Haibo Zhang
ABSTRACT
Background:
High left ventricular end-diastolic diameter (LVEDD) results in worse outcomes in coronary artery bypass grafting (CABG) while referring left ventricular (LV) size and volume measurements to body surface area (BSA) should improve predictability.
Objective:
We propose that BSA weighted LVEDD (bLVEDD) is a more reliable outcome predictor in CABG than only LVEDD.
Methods:
This study was a multi-center retrospective analysis of observational data. Patients admitted between October 2016 and May 2021, were included. All patients were elective surgery patients, and emergency surgery patients were excluded. All subjects were treated with standard care and the clinical data were obtained via the institutional registry following the Society of Thoracic Surgeons National Adult Cardiac Database. The bLVEDD was defined as LVEDD divided by BSA. The primary outcome was in-hospital all-cause mortality (30-day) and the secondary outcomes were postoperative severe adverse events.
Results:
In total, 9,474 patients from five centers under the Chinese Cardiac Surgery Registry were eligible for analysis. A high LVEDD was a negative factor for male patients’ mortality (OR 1.44, P < 0.01) and secondary outcomes. For female patients, the LVEDD was associated with secondary outcomes but did not reach statistical differences for morality. The bLVEDD showed a strong association with post-surgery mortality (OR 2.70, P < 0.01), and secondary outcomes changed in parallel together with bLVEDD in male patients. However, bLVEDD did not reach statistical differences when fitting neither mortality nor severer outcomes in female patients. In male patients, the categorical bLVEDD showed high power to predict mortality (AUC 0.71, P < 0.01), while BSA (AUC 0.62) and LVEDD (AUC 0.64) both contributed to the risk of mortality but were not as significant as the bLVEDD (P <0.01).
Conclusions:
The bLVEDD is an important predictor for male mortality in CABG, removing the bias of BSA and showing a robust ability to fitting mortality.
Citation
Please cite as:
Zhu Z, Li Y, Zhang F, Steiger S, Guo C, Liu N, Lu J, Fan G, Wu W, Wu M, Wang H, Xu D, Chen Y, Zhu J, Meng X, Hou X, Anders HJ, Ye J, Zheng Z, Li C, Zhang H
Prediction of Male Coronary Artery Bypass Grafting Outcomes Using Body Surface Area Weighted Left Ventricular End-diastolic Diameter: Multicenter Retrospective Cohort Study