• Herminia Torrado, Juan C Lopez-Delgado, Elisabet Farrero, David Rodríguez-Castro, María J Castro, Elisabet Periche, Maria L Carriò, Jacobo E Toscano, Alain Pinseau, Casimiro Javierre, and Josep L Ventura.
• Department of Intensive Care, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
• Minerva Cardioangiol. 2016 Apr 1; 64 (2): 101-13.

BackgroundTo determine the clinical risk factors predictive of the 5-year mortality in patients with low cardiac output syndrome (LCOS) after cardiac surgery. In addition, to assess the influence of inflammation and myocardial dysfunction severity, as measured by C-reactive protein (CRP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations, on outcome.MethodsWe studied 30 patients who underwent cardiac surgery and developed postoperative LCOS requiring inotropic support for longer than 48 hours after intensive care unit (ICU) admission. All patients received a 24-hour infusion of levosimendan after study enrolment. We measured the following at baseline, 24 h, 48 h and 7 days: clinical data, serum NT-proBNP and serum CRP levels. Patients were followed-up at 5 years for death by any cause. A risk-adjusted Cox proportional hazards regression model was used for statistical analysis. Hazard ratios and their 95% confidence intervals (CI) are presented.ResultsThe 5-year mortality was 36.6% (n.=11). The predictors of 5-year mortality were the presence of dilated cardiomyopathy (HR=36.909; 95% CI: 1.901-716.747; P=0.017), a higher central venous pressure (CVP) at 48 hours (HR=2.686; 95% CI: 1.383-5.214; P=0.004), and lower CRP levels on day 7 (HR=0.963; 95% CI: 0.933-0.994; P=0.021). NT-proBNP levels showed a trend to higher initial levels in survivors without statistical significance, but were not associated with 5-year mortality.ConclusionsThe presence of dilated cardiomyopathy, elevated CVP at 48 h and reduced CRP levels on day 7 predicted 5-year mortality in patients who developed postoperative LCOS after cardiac surgery. NT-proBNP levels in the first postoperative week were not predictors of long-term outcomes.

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