LV mass index significantly impacts on patient and renal outcomes in patients with coronary artery bypass grafting and poor left-ventricular function

Abstract

Background. A recent report demonstrated that the presence of left ventricular hypertrophy was an independent predictor of mortality in patients with coronary artery bypass grafting (CABG) severely depressed left ventricular function. However, the impact of left ventricle (LV) mass index on the renal and patient outcomes in such patients with CABG has previously not been addressed. The present study thus considers this group of patient and uses LV mass index to assess renal and patient outcomes for these patients. Material and Method. All patients who arrived at the emergency room with severe cardiac dysfunction (EF < 60%), triple vessel disease, and required CABG and LV hypertrophy (LVH) (LV mass index γ110g/m2 in women, γ134g/m2 in men) were admitted preoperatively to the intensive care unit (ICU) for supportive intervention from January 1, 1998 to January 1, 2001. Of all LVH patients, 44 underwent CABG, and were divided into two groups according to LV mass index. Results. Of all patients, 72.7% had severe echocardiographic LVH. The echocardiographic data of both dialysis and non-dialysis groups showed no difference with respect to echocardiographic findings. Histories of myocardial infarction were more frequent in the severe LVH group that in the mild LVH group. As for pre-operative systolic blood pressure and diastolic blood pressure, mean systolic and diastolic blood pressure values were significantly lower in the severe LVH group. Ejection fraction was also significantly lower in the severe LVH group than in the mild LVH group. The patients in the severe LVH group were significantly more likely to have received hemodialysis following CABG surgery (62.5% vs. 33.4%, p < 0.05). Mortality was higher in the higher LV mass index group that in the lower LV mass index group (56.2% vs. 25%, p < 0.05). Conclusion. Patients with a significantly higher LV mass index usually manifest lower pre-operative blood pressure and poor cardiac function. Consequently, these patients will have a poor renal outcome and higher mortality.