The transition and outcomes of perioperative low ejection fraction status in cardiac surgical patients

Low left ventricular ejection fraction (LVEF) was always considered a high-risk factor for surgery. A growing number of patients with preoperative low LVEF have undergone cardiac surgery in recent years. The transition of postoperative LVEF and its correlation with shortterm outcomes is not yet clear. We retrospectively collected the clinical data of cardiac surgery patients with low preoperative LVEF (<= 40%). LVEF measurements were collected preoperatively and at least twice postoperatively. The primary endpoint was the composite endpoint of hospital mortality or length of intensive care unit (ICU) stay >= 7 days. Univariate logistic regression was used to evaluate the association of each indicator with the outcomes, including calculation of the area under the receiver operating characteristic (ROC) curve. A two-piecewise linear regression model was applied to examine the threshold effect of the LVEFon the composite endpoint using a smoothing function. From 1 January to 31 December 2018, a total of 123 patients had low LVEF preoperatively, of whom 35 (28.5%) met the composite endpoint. LVEF was 35% [interquartile range (IQR) 30%-42%] at first measurement and increased to 40% (IQR 35%45%) at final measurement during their hospitalization. There was a linear relationship between composite endpoint and lowest level of postoperative LVEE The base e logarithm of odds ratio [Ln(OR)] of composite endpoint decreased with increasing LVEF (OR = 0.83,95% confidence interval 0.76-0.91, p < 0.01). Most patients with low preoperative LVEF will benefit from cardiac surgery. The lowest measurement of postoperative LVEF can be used to evaluate the shortterm outcome of patients after cardiac surgery.