Deterioration of Regional Wall Motion Immediately after Coronary Artery Bypass Graft Surgery Is Associated with Long-term Major Adverse Cardiac Events

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Abstract
PATIENTS undergoing cardiac surgery frequently develop segmental wall motion abnormalities (WMAs) diagnosed by transesophageal echocardiography (TEE). In the setting of coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB), WMAs found after revascularization are multifactorial and dynamic in nature. Although the association of hibernating myocardium detected by dobutamine stress echocardiography or nuclear imaging with adverse outcomes after CABG surgery has been reported, little is known about the extent to which new intraoperative WMAs are predictive of morbidity and mortality after CABG surgery. In a study by Leung et al. ,1 post-CPB episodes of worsening wall motion were found to be associated with an increased incidence of myocardial infarction (MI), cardiogenic shock, or death during the period of hospitalization. Similarly, Comunale et al. 2 showed that WMAs occurring at any point intraoperatively in CABG patients conferred an increased risk of developing an early postoperative MI. Both of these studies, however, were limited by the use of short-term outcomes and a single four-segment transgastric midpapillary view of the left ventricle.

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