Diastolic Dysfunction in the Left Ventricle and Its Prediction Systems
Keywords:
CABG, diastolic dysfunction, EuroSCORE II, STS, MAGGIC, prognosis, NRI, IDIAbstract
Objective. To evaluate the universal prognostic value of left ventricular diastolic dysfunction (LVDD) when added to various clinical risk scores (EuroSCORE II, STS, MAGGIC) in patients undergoing coronary artery bypass grafting (CABG).
Materials and Methods. The study included 178 patients with coronary artery disease who underwent elec-tive CABG. Clinical, echocardiographic, and functional parameters were analyzed, including the assessment of left ventricular diastolic function. EuroSCORE II, STS, and MAGGIC risk scores were calculated for all patients. The prognostic value of the models was assessed using ROC analysis (AUC), DeLong test, risk reclassification indices (NRI, IDI), and Decision Curve Analysis.
Results. Left ventricular diastolic dysfunction was an independent predictor of postoperative complications. The addition of LVDD to the EuroSCORE II, STS, and MAGGIC models significantly improved their discrimi-native ability (ΔAUC = 0.07–0.08; p < 0.05 for all models). NRI and IDI indices demonstrated a statistically significant improvement in risk stratification across all models. Decision Curve Analysis showed increased clinical usefulness of the combined models across a wide range of risk thresholds.
Conclusion. LVDD is a universal functional risk modifier that improves the prognostic accuracy of various clinical models. Inclusion of left ventricular diastolic function assessment in preoperative risk stratification algo-rithms for CABG may significantly improve clinical decision-making.
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References
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