HOSTED BY Echocardiographic Predictors of Immediate Postoperative Outcomes in Patients With Severe Left Ventricular Systolic Dysfunction Undergoing On-Pump Coronary Artery Bypass Grafting Ajay Kumar Jha, MD, DM 1 , Vishwas Malik, MD, DM, Parag Gharde, MD, DM, Sandeep Chauhan, MD, Usha Kiran, MD, Milind P. Hote, MS, MCH All India Institute of Medical Sciences, New Delhi, India Objectives: The postoperative course following on-pump coronary artery bypass grafting (CABG) in patients with severe left ventricular (LV) systolic dysfunction is often unpredictable. Therefore, the aim of this study was to identify predictors of poor postoperative outcome in this subset of patients. Design: Prospective observational study Setting: Single university hospital Participants: Forty patients with severe LV systolic dysfunction undergoing isolated on-pump CABG Interventions: None Measurements and Main Results: Comprehensive transesophageal echocardiographic examination was performed to obtain the indices of systolic and diastolic LV function after induction of anesthesia. A poor postoperative outcome was defined as patient death or vasoactive inotropic score Z20 for at least 6 hours and/or requiring intra-aortic balloon counterpulsation and/or mechanical ventilation for Z24 hours. Poor postoperative outcome was observed in 40% (16/40) of patients. Patients with poor postoperative outcomes had a significantly higher systolic dyssynchrony index, septal-lateral delay with a significantly lower global longitudinal strain and isovolumic acceleration, end-diastolic volume, end-systolic volume, and lateral and medial mitral annulus systolic velocity. In a binary logistic regression model, global longitudinal strain (odds ratio, 1.5, confidence interval [CI] 95%, 1.19-1.88, p ¼ 0.001), septal-lateral delay (odds ratio, 1.02, 95% CI, 1.01-1.03; p ¼ 0.001) and systolic dyssychrony index (odds ratio, 1.3, 95% CI, 1.13-1.48; p ¼ 0.000) were found to be predictors of poor postoperative outcome. Conclusion: Global longitudinal strain, systolic dyssynchrony index, and septal-lateral delay were reliable and accurate predictors of adverse outcomes in patients with severe LV systolic dysfunction undergoing on-pump CABG. & 2017 Elsevier Inc. All rights reserved. Key Words: anesthesia; coronary artery bypass grafting; echocardiography; outcome; predictors DESPITE IMPROVEMENTS in medical therapies and surgical techniques, the appropriate management of patients with coronary artery disease and severe left ventricular (LV) systolic dysfunction is still replete with controversies. 1-5 Coronary artery bypass grafting (CABG) is preferred over medical therapy in coronary artery disease with severe left ventricular systolic dysfunction and has acceptable postopera- tive cardiovascular morbidity and mortality. 6-8 However, the postoperative course following CABG in patients with severe LV systolic dysfunction is often unpredictable. Patients often require higher doses and longer duration of inotropes, Contents lists available at ScienceDirect journal homepage: www.jcvaonline.com http://dx.doi.org/10.1053/j.jvca.2016.04.025 1053-0770/& 2017 Elsevier Inc. All rights reserved. Conflicts of interest: None. 1 Address reprint requests to A.K. Jha, MD, DM, All India Institute of Medical Sciences, Department of Cardiac Anaesthesia, CN Centre, New Delhi, India. E-mail address: ajaykjha1212@gmail.com (A.K. Jha). Journal of Cardiothoracic and Vascular Anesthesia 31 (2017) 184–190