Utility of a simple algorithm to grade diastolic dysfunction and predict outcome after coronary artery bypass graft surgery

Madhav Swaminathan, Alina Nicoara, Barbara G. Phillips-Bute, Nicolas Aeschlimann, Carmelo A. Milano, G. Burkhard MacKensen, Mihai V. Podgoreanu, Eric J. Velazquez, Mark Stafford-Smith, Joseph P. Mathew, James A. Blumenthal, Solomon Aronson, J. Mauricio Del Rio, Katherine P. Grichnik, Steven E. Hill, Andre Motie, Mark F. Newman, Ian J. Welsby, William D. White, Bonita L. Funk & 32 others Roger L. Hall, Gladwell Mbochi, Tiffany Bisanar, Prometheus T. Solon, Peter Waweru, Carolyn M. Thompson, Karen L. Clemmons, Jacquelane Libed, Yanne Toulgoat-Dubois, Michael A. Babyak, Daniel B. Mark, Michael H. Sketch, Ellen R. Bennett, Carmelo Graffagnino, Daniel T. Laskowitz, Warren J. Strittmatter, Kathleen A. Welsh-Bohmer, Kevin Collins, Greg Smigla, Ian Shearer, Thomas A. D'Amico, Mark Berry, R. Duane Davis, Jeffrey Gaca, Donald D. Glower, David Harpole, G. Chad Hughes, Shu S. Lin, Andrew Lodge, Mark Onaitis, Peter K. Smith, Betty Tong

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

Background: Inclusion of a measure of left ventricular diastolic dysfunction (LVDD) may improve risk prediction after cardiac surgery. Current LVDD grading guidelines rely on echocardiographic variables that are not always available or aligned to allow grading. We hypothesized that a simplified algorithm involving fewer variables would enable more patients to be assigned a LVDD grade compared with a comprehensive algorithm, and also be valid in identifying patients at risk of long-term major adverse cardiac events (MACE). Methods: Intraoperative transesophageal echocardiography data were gathered on 905 patients undergoing coronary artery bypass graft surgery, including flow and tissue Doppler-based measurements. Two algorithms were constructed to categorize LVDD: a comprehensive four-variable algorithm, A, was compared with a simplified version, B, with only two variables - transmitral early flow velocity and early mitral annular tissue velocity - for ease of grading and association with MACE. Results: Using algorithm A, only 563 patients (62%) could be graded, whereas 895 patients (99%) received a grade with algorithm B. Over the median follow-up period of 1,468 days, Cox modeling showed that LVDD was significantly associated with MACE when graded with algorithm B (p = 0.013), but not algorithm A (p = 0.79). Patients with the highest incidence of MACE could not be graded with algorithm A. Conclusions: We found that an LVDD algorithm with fewer variables enabled grading of a significantly greater number of coronary artery bypass graft patients, and was valid, as evidenced by worsening grades being associated with MACE. This simplified algorithm could be extended to similar populations as a valid method of characterizing LVDD.

Original languageEnglish (US)
Pages (from-to)1844-1850
Number of pages7
JournalAnnals of Thoracic Surgery
Volume91
Issue number6
DOIs
StatePublished - Jun 2011

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Coronary Artery Bypass
Left Ventricular Dysfunction
Transplants
Transesophageal Echocardiography
Thoracic Surgery
Guidelines
Incidence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Swaminathan, M., Nicoara, A., Phillips-Bute, B. G., Aeschlimann, N., Milano, C. A., MacKensen, G. B., ... Tong, B. (2011). Utility of a simple algorithm to grade diastolic dysfunction and predict outcome after coronary artery bypass graft surgery. Annals of Thoracic Surgery, 91(6), 1844-1850. https://doi.org/10.1016/j.athoracsur.2011.02.008

Utility of a simple algorithm to grade diastolic dysfunction and predict outcome after coronary artery bypass graft surgery. / Swaminathan, Madhav; Nicoara, Alina; Phillips-Bute, Barbara G.; Aeschlimann, Nicolas; Milano, Carmelo A.; MacKensen, G. Burkhard; Podgoreanu, Mihai V.; Velazquez, Eric J.; Stafford-Smith, Mark; Mathew, Joseph P.; Blumenthal, James A.; Aronson, Solomon; Del Rio, J. Mauricio; Grichnik, Katherine P.; Hill, Steven E.; Motie, Andre; Newman, Mark F.; Welsby, Ian J.; White, William D.; Funk, Bonita L.; Hall, Roger L.; Mbochi, Gladwell; Bisanar, Tiffany; Solon, Prometheus T.; Waweru, Peter; Thompson, Carolyn M.; Clemmons, Karen L.; Libed, Jacquelane; Toulgoat-Dubois, Yanne; Babyak, Michael A.; Mark, Daniel B.; Sketch, Michael H.; Bennett, Ellen R.; Graffagnino, Carmelo; Laskowitz, Daniel T.; Strittmatter, Warren J.; Welsh-Bohmer, Kathleen A.; Collins, Kevin; Smigla, Greg; Shearer, Ian; D'Amico, Thomas A.; Berry, Mark; Davis, R. Duane; Gaca, Jeffrey; Glower, Donald D.; Harpole, David; Hughes, G. Chad; Lin, Shu S.; Lodge, Andrew; Onaitis, Mark; Smith, Peter K.; Tong, Betty.

In: Annals of Thoracic Surgery, Vol. 91, No. 6, 06.2011, p. 1844-1850.

Research output: Contribution to journalArticle

Swaminathan, M, Nicoara, A, Phillips-Bute, BG, Aeschlimann, N, Milano, CA, MacKensen, GB, Podgoreanu, MV, Velazquez, EJ, Stafford-Smith, M, Mathew, JP, Blumenthal, JA, Aronson, S, Del Rio, JM, Grichnik, KP, Hill, SE, Motie, A, Newman, MF, Welsby, IJ, White, WD, Funk, BL, Hall, RL, Mbochi, G, Bisanar, T, Solon, PT, Waweru, P, Thompson, CM, Clemmons, KL, Libed, J, Toulgoat-Dubois, Y, Babyak, MA, Mark, DB, Sketch, MH, Bennett, ER, Graffagnino, C, Laskowitz, DT, Strittmatter, WJ, Welsh-Bohmer, KA, Collins, K, Smigla, G, Shearer, I, D'Amico, TA, Berry, M, Davis, RD, Gaca, J, Glower, DD, Harpole, D, Hughes, GC, Lin, SS, Lodge, A, Onaitis, M, Smith, PK & Tong, B 2011, 'Utility of a simple algorithm to grade diastolic dysfunction and predict outcome after coronary artery bypass graft surgery', Annals of Thoracic Surgery, vol. 91, no. 6, pp. 1844-1850. https://doi.org/10.1016/j.athoracsur.2011.02.008
Swaminathan, Madhav ; Nicoara, Alina ; Phillips-Bute, Barbara G. ; Aeschlimann, Nicolas ; Milano, Carmelo A. ; MacKensen, G. Burkhard ; Podgoreanu, Mihai V. ; Velazquez, Eric J. ; Stafford-Smith, Mark ; Mathew, Joseph P. ; Blumenthal, James A. ; Aronson, Solomon ; Del Rio, J. Mauricio ; Grichnik, Katherine P. ; Hill, Steven E. ; Motie, Andre ; Newman, Mark F. ; Welsby, Ian J. ; White, William D. ; Funk, Bonita L. ; Hall, Roger L. ; Mbochi, Gladwell ; Bisanar, Tiffany ; Solon, Prometheus T. ; Waweru, Peter ; Thompson, Carolyn M. ; Clemmons, Karen L. ; Libed, Jacquelane ; Toulgoat-Dubois, Yanne ; Babyak, Michael A. ; Mark, Daniel B. ; Sketch, Michael H. ; Bennett, Ellen R. ; Graffagnino, Carmelo ; Laskowitz, Daniel T. ; Strittmatter, Warren J. ; Welsh-Bohmer, Kathleen A. ; Collins, Kevin ; Smigla, Greg ; Shearer, Ian ; D'Amico, Thomas A. ; Berry, Mark ; Davis, R. Duane ; Gaca, Jeffrey ; Glower, Donald D. ; Harpole, David ; Hughes, G. Chad ; Lin, Shu S. ; Lodge, Andrew ; Onaitis, Mark ; Smith, Peter K. ; Tong, Betty. / Utility of a simple algorithm to grade diastolic dysfunction and predict outcome after coronary artery bypass graft surgery. In: Annals of Thoracic Surgery. 2011 ; Vol. 91, No. 6. pp. 1844-1850.
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abstract = "Background: Inclusion of a measure of left ventricular diastolic dysfunction (LVDD) may improve risk prediction after cardiac surgery. Current LVDD grading guidelines rely on echocardiographic variables that are not always available or aligned to allow grading. We hypothesized that a simplified algorithm involving fewer variables would enable more patients to be assigned a LVDD grade compared with a comprehensive algorithm, and also be valid in identifying patients at risk of long-term major adverse cardiac events (MACE). Methods: Intraoperative transesophageal echocardiography data were gathered on 905 patients undergoing coronary artery bypass graft surgery, including flow and tissue Doppler-based measurements. Two algorithms were constructed to categorize LVDD: a comprehensive four-variable algorithm, A, was compared with a simplified version, B, with only two variables - transmitral early flow velocity and early mitral annular tissue velocity - for ease of grading and association with MACE. Results: Using algorithm A, only 563 patients (62{\%}) could be graded, whereas 895 patients (99{\%}) received a grade with algorithm B. Over the median follow-up period of 1,468 days, Cox modeling showed that LVDD was significantly associated with MACE when graded with algorithm B (p = 0.013), but not algorithm A (p = 0.79). Patients with the highest incidence of MACE could not be graded with algorithm A. Conclusions: We found that an LVDD algorithm with fewer variables enabled grading of a significantly greater number of coronary artery bypass graft patients, and was valid, as evidenced by worsening grades being associated with MACE. This simplified algorithm could be extended to similar populations as a valid method of characterizing LVDD.",
author = "Madhav Swaminathan and Alina Nicoara and Phillips-Bute, {Barbara G.} and Nicolas Aeschlimann and Milano, {Carmelo A.} and MacKensen, {G. Burkhard} and Podgoreanu, {Mihai V.} and Velazquez, {Eric J.} and Mark Stafford-Smith and Mathew, {Joseph P.} and Blumenthal, {James A.} and Solomon Aronson and {Del Rio}, {J. Mauricio} and Grichnik, {Katherine P.} and Hill, {Steven E.} and Andre Motie and Newman, {Mark F.} and Welsby, {Ian J.} and White, {William D.} and Funk, {Bonita L.} and Hall, {Roger L.} and Gladwell Mbochi and Tiffany Bisanar and Solon, {Prometheus T.} and Peter Waweru and Thompson, {Carolyn M.} and Clemmons, {Karen L.} and Jacquelane Libed and Yanne Toulgoat-Dubois and Babyak, {Michael A.} and Mark, {Daniel B.} and Sketch, {Michael H.} and Bennett, {Ellen R.} and Carmelo Graffagnino and Laskowitz, {Daniel T.} and Strittmatter, {Warren J.} and Welsh-Bohmer, {Kathleen A.} and Kevin Collins and Greg Smigla and Ian Shearer and D'Amico, {Thomas A.} and Mark Berry and Davis, {R. Duane} and Jeffrey Gaca and Glower, {Donald D.} and David Harpole and Hughes, {G. Chad} and Lin, {Shu S.} and Andrew Lodge and Mark Onaitis and Smith, {Peter K.} and Betty Tong",
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T1 - Utility of a simple algorithm to grade diastolic dysfunction and predict outcome after coronary artery bypass graft surgery

AU - Swaminathan, Madhav

AU - Nicoara, Alina

AU - Phillips-Bute, Barbara G.

AU - Aeschlimann, Nicolas

AU - Milano, Carmelo A.

AU - MacKensen, G. Burkhard

AU - Podgoreanu, Mihai V.

AU - Velazquez, Eric J.

AU - Stafford-Smith, Mark

AU - Mathew, Joseph P.

AU - Blumenthal, James A.

AU - Aronson, Solomon

AU - Del Rio, J. Mauricio

AU - Grichnik, Katherine P.

AU - Hill, Steven E.

AU - Motie, Andre

AU - Newman, Mark F.

AU - Welsby, Ian J.

AU - White, William D.

AU - Funk, Bonita L.

AU - Hall, Roger L.

AU - Mbochi, Gladwell

AU - Bisanar, Tiffany

AU - Solon, Prometheus T.

AU - Waweru, Peter

AU - Thompson, Carolyn M.

AU - Clemmons, Karen L.

AU - Libed, Jacquelane

AU - Toulgoat-Dubois, Yanne

AU - Babyak, Michael A.

AU - Mark, Daniel B.

AU - Sketch, Michael H.

AU - Bennett, Ellen R.

AU - Graffagnino, Carmelo

AU - Laskowitz, Daniel T.

AU - Strittmatter, Warren J.

AU - Welsh-Bohmer, Kathleen A.

AU - Collins, Kevin

AU - Smigla, Greg

AU - Shearer, Ian

AU - D'Amico, Thomas A.

AU - Berry, Mark

AU - Davis, R. Duane

AU - Gaca, Jeffrey

AU - Glower, Donald D.

AU - Harpole, David

AU - Hughes, G. Chad

AU - Lin, Shu S.

AU - Lodge, Andrew

AU - Onaitis, Mark

AU - Smith, Peter K.

AU - Tong, Betty

PY - 2011/6

Y1 - 2011/6

N2 - Background: Inclusion of a measure of left ventricular diastolic dysfunction (LVDD) may improve risk prediction after cardiac surgery. Current LVDD grading guidelines rely on echocardiographic variables that are not always available or aligned to allow grading. We hypothesized that a simplified algorithm involving fewer variables would enable more patients to be assigned a LVDD grade compared with a comprehensive algorithm, and also be valid in identifying patients at risk of long-term major adverse cardiac events (MACE). Methods: Intraoperative transesophageal echocardiography data were gathered on 905 patients undergoing coronary artery bypass graft surgery, including flow and tissue Doppler-based measurements. Two algorithms were constructed to categorize LVDD: a comprehensive four-variable algorithm, A, was compared with a simplified version, B, with only two variables - transmitral early flow velocity and early mitral annular tissue velocity - for ease of grading and association with MACE. Results: Using algorithm A, only 563 patients (62%) could be graded, whereas 895 patients (99%) received a grade with algorithm B. Over the median follow-up period of 1,468 days, Cox modeling showed that LVDD was significantly associated with MACE when graded with algorithm B (p = 0.013), but not algorithm A (p = 0.79). Patients with the highest incidence of MACE could not be graded with algorithm A. Conclusions: We found that an LVDD algorithm with fewer variables enabled grading of a significantly greater number of coronary artery bypass graft patients, and was valid, as evidenced by worsening grades being associated with MACE. This simplified algorithm could be extended to similar populations as a valid method of characterizing LVDD.

AB - Background: Inclusion of a measure of left ventricular diastolic dysfunction (LVDD) may improve risk prediction after cardiac surgery. Current LVDD grading guidelines rely on echocardiographic variables that are not always available or aligned to allow grading. We hypothesized that a simplified algorithm involving fewer variables would enable more patients to be assigned a LVDD grade compared with a comprehensive algorithm, and also be valid in identifying patients at risk of long-term major adverse cardiac events (MACE). Methods: Intraoperative transesophageal echocardiography data were gathered on 905 patients undergoing coronary artery bypass graft surgery, including flow and tissue Doppler-based measurements. Two algorithms were constructed to categorize LVDD: a comprehensive four-variable algorithm, A, was compared with a simplified version, B, with only two variables - transmitral early flow velocity and early mitral annular tissue velocity - for ease of grading and association with MACE. Results: Using algorithm A, only 563 patients (62%) could be graded, whereas 895 patients (99%) received a grade with algorithm B. Over the median follow-up period of 1,468 days, Cox modeling showed that LVDD was significantly associated with MACE when graded with algorithm B (p = 0.013), but not algorithm A (p = 0.79). Patients with the highest incidence of MACE could not be graded with algorithm A. Conclusions: We found that an LVDD algorithm with fewer variables enabled grading of a significantly greater number of coronary artery bypass graft patients, and was valid, as evidenced by worsening grades being associated with MACE. This simplified algorithm could be extended to similar populations as a valid method of characterizing LVDD.

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