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

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

Research output: Contribution to journalArticle

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

Original languageEnglish (US)
Pages (from-to)1643-1651e2
JournalJournal of Thoracic and Cardiovascular Surgery
Volume149
Issue number6
DOIs
StatePublished - 2015
Externally publishedYes

Keywords

  • echocardiography
  • outcomes
  • radiation-associated cardiac disease
  • strain

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine
  • Medicine(all)

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    Chirakarnjanakorn, S., Popović, Z. B., Wu, W., Masri, A., Smedira, N. G., Lytle, B. W., Griffin, B. P., & Desai, M. Y. (2015). Impact of long-axis function on cardiac surgical outcomes in patients with radiation-associated heart disease. Journal of Thoracic and Cardiovascular Surgery, 149(6), 1643-1651e2. https://doi.org/10.1016/j.jtcvs.2015.01.045