الفهرس 
PHYSIOLOGY OF LEFT VENTRICULAR FUNCTIONOnly 14 pages are availabe for public view
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Abstract
Background: To assess results after CABG in patients with reduced EF (≤40%) but viable myocardium and to determine the possible predictors of postoperative outcome depending on preoperative dobutamine stress echocardiography results.
Patients and Methods: The study included 110 patients who underwent isolated elective on-pump CABG with LVEF < 40%. This study was conducted at Departments of Cardiothoracic surgery in Ain-Shams University Hospital, Nasr City Insurance Hospital, and Minia University Hospital. This prospective observational study was conducted over one year with a follow-up period of 6 months.
Results: The study approved a statistically significant increase in NYHA class I and CCS grades I and II. Changes in the findings of trans-thoracic echocardiography postoperatively and at the end of the follow-up period in survivors compared to preoperative values were statistically significant in the form of improvements in left ventricular dimensions, left ventricular ejection fraction, and segmental wall motion abnormalities. On univariable analysis of the predictors of in-hospital mortality, the significant predictors were age > 60 years, peak WMSI on DSE >1.5, improvement of LVEF on DSE <10%, insertion of IABP (intra- or postoperative), and incomplete revascularization. On multivariable analysis of the predictors of in-hospital mortality, insertion of IABP was the only significant predictor of mortality.
Conclusion: CABG for dysfunctioning but viable myocardium enhances LV recovery of function and ensures acceptable survival. Results of dobutamine stress echocardiography in patients with low LVEF are predictive for clinical improvement. Therefore, assessment of WMSI and LVEF with dobutamine echocardiography may be the optimal means of evaluating the impact of viability on prognosis.