SENSITIVITY AND SPECIFICITY OF PREOPERATIVE ECHOCARDIOGRAPHIC PARAMETERS IN QUALITY OF LIFE PREDICTION FIVE YEARS AFTER CORONARY ARTERY BYPASS GRAFT SURGERY
Purpose: Factors associated with mortality and morbidity following coronary artery bypass graft surgery have been well defined and the Parsonnet score is widely used in mortality prediction. The evaluation of quality of life still is not implemented in everyday work and preoperative echocardiographic factors influencing the quality of life in patients undergoing coronary artery bypass graft surgery are poorly documented. The aim of the study was to evaluate echocardiographic parameters influencing quality of life following coronary artery bypass graft surgery and its correlation with widely used Parsonnet score.
Methods: 449 consecutive patients with myocardial revascularization, operated during 1999. and 2000., were enrolled in this retrospective-prospective study, patients with co-morbidities were excluded as well as patients where it was not possible to do complete myocardial revascularization. Group of 180 patients who accepted to participate in quality of life evaluation was followed for 60 months. The quality of life was evaluated using questionnaire SF-36.
Results: Mean patients age was 57.8+/-7.8 years, 79.4% were males. 5 years survival was 84.2 %. Mean number of risk factors was 3.4+/-1.0. Most of the patients were in NYHA II class (104 of them or 59.4%), 61 of them (34.9%) in NYHA III class and only 10 patients or 5.7% of them were in NYHA IV class. Mean EDD was 55.3+/-5.6 mm, mean EDS 38.7+/-5.6 mm and mean EF 51.7+/-9.6 %. Left atrium dilatation (p<0.001), as well as left ventricle dilatation (p<0.001), low left ventricle ejection fraction (p<0.001), multisegmental disorders of contractility (p<0.001), and severe mitral regurgitation (p<0.001) had negative correlation with almost all dimensions of quality of life. ROC analysis showed that left ventricle EDD of 54.5 mm can be used as good cut-off value for prediction of optimal quality of life, with sensitivity of 57% and specificity of 70% (RR=1.386), left ventricle ESD of 37.5 mm with sensitivity of 65% and specificity of 57% (RR=0.855) and left ventricle EF of 50% with sensitivity of 61% and specificity of 70% (RR=0.916).
Conclusions: Echocardiographic parameters, that can easily be obtained preoperatively, have strong predictive value not only in postoperative survival but also in determination of quality of life five years after coronary artery bypass graft surgery.