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Value of echocardiography for stroke and mortality prediction following coronary artery bypass grafting

^a Department of Cardiology, Echocardiographic Unit, Rabin Medical Center, Beilinson Campus, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
^b Department of Cardiothoracic Surgery, Rabin Medical Center, Beilinson Campus, 49100 Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

*Corresponding author. Tel.: +972-3-9376710; fax: +972-3-9240762.

E-mail address: berman_marius{at}yahoo.com (M. Berman).

There are known clinical and laboratory predictors for stroke and death following CABG. The aim of this study was to determine if transthoracic echocardiographic findings prior to CABG have additional predictive value for occurrence of perioperative cerebrovascular accident (CVA) and death. The files of patients who underwent CABG between January 2002 and November 2004, with perioperative echocardiographic assessment were reviewed. Echocardiographic variables examined included LV size, function and hypertrophy, mitral annulus calcification (MAC) and aortic valve calcification (AVC). Patients in whom post-CABG stroke or death was documented were compared with those without these endpoints. Of the 572 patients who met the study criteria, 33 (5.8%) had a neurological event and 26 (4.5%) died, four after a major stroke. One hundred and sixty-seven patients had MAC and 228 AVC. On multivariate analysis, risk factors for stroke were previous stroke (OR=2.91 CI 1.179–7.24; P<0.005), renal failure (OR=2.48 CI 1.039–5.95; P<0.001) and older age (OR=1.60 CI 0.971–2.63; P<0.001); risk factors for death were perioperative insertion of intra-aortic balloon pump (OR=33.7 CI 11.38–100; P<0.001) and peripheral vascular disease (OR=3.89 CI 1.32–11.45; P<0.001). Medically treated dyslipidemia was protective factor. LV hypertrophy significantly predicts stroke post-CABG by univariate analysis (P=0.02). There was no significant correlation between AVC and MAC with stroke, although death was slightly increased in patients with MAC (44% vs. 29.2%, P=0.114).

Key Words: Risk stratification; Mitral annulus calcification; Aortic valve calcification; Stroke; Mortality; LV mass; CABG