• Coronary Artery Bypass Grafting
• Ischemic Cardiomyopathy
• Left Ventricular Ejection Fraction
• Regional Wall Motion

Background: Ischemic heart disease is a major contributor to systolic heart failure. While CABG may improve left ventricular function by restoring contractility in hibernating myocardium, its effectiveness, particularly in patients with reduced or mildly reduced LVEF, remains under debate. This study explores the impact of CABG on both global ejection fraction and regional wall motion, focusing on the relationship between targeted revascularization and functional myocardial recovery.
Methods: A retrospective, single-center study was conducted at the University of Pisa, enrolling patients with preoperative LVEF <50% who underwent CABG from 2021 to 2024. Echocardiographic parameters (LVEF and regional wall motion) were evaluated pre- and post-surgery. Clinical, procedural, and pharmacological factors were also assessed for their association with cardiac function recovery. Linear and logistic regression models were used to analyze LVEF and regional motion changes, accounting for potential confounders such as diabetes, BMI, revascularization completeness, and use of specific medications or support. A p-value <0.05 was considered statistically significant.
Results: Postoperative LVEF significantly improved, with a mean increase of 6.4% (95% CI: 4.8–8.0, p < 0.001). This enhancement was positively associated with beta-blocker use and the number of grafts performed. ACE inhibitor use correlated with higher odds of achieving LVEF >35% postoperatively, whereas SGLT2 inhibitor therapy and intra-aortic balloon pump support were linked to lower odds. Additionally, significant improvements in regional wall motion were observed across all myocardial territories, although no correlation was found between functional recovery and revascularization status of the corresponding or adjacent segments.
Conclusions: In patients with ischemic heart disease and impaired left ventricular function, surgical revascularization via CABG was associated with a significant improvement in both global systolic function, as measured by LVEF, and regional wall motion. While certain preoperative clinical factors, such as beta-blocker use and the extent of grafting, were correlated with greater functional recovery, revascularization of specific myocardial territories did not consistently predict segmental improvement. These findings support the role of CABG in selected patients with reduced LVEF and underscore the multifactorial nature of myocardial functional recovery.