Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Aug;24(8):1427-1438.
doi: 10.1002/ejhf.2446. Epub 2022 Mar 10.

Revascularization in ischaemic heart failure with preserved ejection fraction: a nationwide cohort study

Salil V Deo  1   2 , Yogesh N V Reddy  3 , Rosita Zakeri  4 , Mohamad Karnib  1   2   5 , Padmini Selvaganesan  1   2 , Yakov Elgudin  1   2   5 , Ahmet Kilic  6 , Joseph Rubelowsky  1 , Salah E Altarabsheh  7 , Mohammed N Osman  1   2   5 , Richard A Josephson  2   5 , Sri Krishna Madan Mohan  1 , Brian Cmolik  1   2 , Daniel I Simon  2   5 , Sanjay Rajagopalan  2   5 , John G F Cleland  8 , Jayakumar Sahadevan  1   2 , Varun Sundaram  1   2   5
Affiliations
Free article

Revascularization in ischaemic heart failure with preserved ejection fraction: a nationwide cohort study

Salil V Deo et al. Eur J Heart Fail. 2022 Aug.
Free article

Abstract

Aims: Despite the common occurrence of coronary artery disease (CAD) and heart failure (HF) with preserved ejection fraction (HFpEF), there is limited evidence to guide revascularization.

Methods and results: We investigated the long-term outcomes of coronary artery bypass grafting (CABG) in patients with HF and significant CAD across the spectrum of ejection fraction, using a large national cohort of patients from the Veteran Affairs (VA) Medical Centers in the US. Patients with HF were stratified into groups, HFpEF, HF with mid-range ejection fraction (HFmrEF), and HF with reduced ejection fraction (HFrEF) and compared to patients with no preoperative HF. We analysed 10 396 patients. Despite an increased hazard in the first year following revascularization, the long-term survival (median follow-up 6.6 years; interquartile range 3.7-10.1) of HFpEF post-CABG was similar to controls (hazard ratio 0.85, 95% confidence interval 0.68-1.06), but survival progressively declined with HFmrEF and HFrEF. Similar trends were seen with recurrent HF hospitalization with lower risk with baseline HFpEF (43.9 ± 6.9/100 patient-years) compared to HFmrEF (65.9 ± 3.8/100 patient-years) and HFrEF (93.4 ± 4.8/100 patient-years). Although HFpEF patients had lower mortality and HF hospitalization post-CABG compared to patients with a lower ejection fraction, they experienced the highest rates of future myocardial infarction.

Conclusion: Although HFpEF patients with CAD have greater short-term risk post-CABG, their long-term survival is comparable to controls. However, they are at increased risk for HF hospitalizations and myocardial infarction. These data support the safety of CABG in HFpEF patients and suggest continuum of mortality risk for ischaemic HF when stratified by baseline ejection fraction before revascularization.

Keywords: Coronary artery bypass grafting; Coronary artery disease; Ejection fraction; Heart failure; Survival.

PubMed Disclaimer

Comment in

References

    1. Borlaug BA, Paulus WJ. Heart failure with preserved ejection fraction: pathophysiology, diagnosis, and treatment. Eur Heart J. 2011;32:670-9.
    1. Shah SJ, Katz DH, Deo RC. Phenotypic spectrum of heart failure with preserved ejection fraction. Heart Fail Clin. 2014;10:407-18.
    1. Paulus WJ, Tschöpe C. A novel paradigm for heart failure with preserved ejection fraction: comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation. J Am Coll Cardiol. 2013;62:263-71.
    1. Mohammed SF, Hussain S, Mirzoyev SA, Edwards WD, Maleszewski JJ, Redfield MM. Coronary microvascular rarefaction and myocardial fibrosis in heart failure with preserved ejection fraction. Circulation. 2015;131:550-9.
    1. Tromp J, Hage C, Ouwerkerk W, Sanders-van Wijk S, Svedlund S, Saraste A, et al. Biomarker correlates of coronary microvascular dysfunction in heart failure with preserved ejection fraction. Circulation 2019;140:1359-61.