Senior R, Lahiri A, Kaul S
Department of Cardiovascular Medicine, Northwick Park, Harrow, United Kingdom.
Am J Cardiol. 2001 Sep 15;88(6):624-9. doi: 10.1016/s0002-9149(01)01803-3.
Few data exist regarding the effect of revascularization on left ventricular (LV) geometry in patients with severe LV systolic dysfunction and viable myocardium. We hypothesized that patients with chronic ischemic LV dysfunction but viable myocardium will have improved LV geometry after revascularization, which in turn will improve long-term outcome. Accordingly, 70 patients with severe ischemic LV dysfunction (LV ejection fraction <0.35) were studied at rest. They then either underwent revascularization (n = 36) or were treated medically (n = 34). Fifty-four patients had viable myocardium, and 16 did not. They were evaluated for change in LV function and geometry (size and shape) a mean of 21 months later. Further follow-up was performed for a mean of 3.5 years to determine outcome. Patients with viable myocardium had improvement not only in regional and global function, but also in LV geometry (shape and size), which was independent of and incremental to the improvement in function. On long-term follow-up, change in LV end-systolic volume was the only multivariate discriminator between 15 patients who died and 55 who did not, irrespective of whether they had undergone revascularization. Thus, measurement of the effect of revascularization of viable myocardium in chronic ischemic heart disease should not only include improvement in resting regional and global LV function, but also LV geometry. Improvement in LV geometry contributes to better LV systolic function, which in turn is the best predictor of survival after revascularization.
关于血管重建术对严重左心室(LV)收缩功能障碍且存在存活心肌的患者左心室几何形态的影响,现有数据较少。我们推测,慢性缺血性左心室功能障碍但存在存活心肌的患者在血管重建术后左心室几何形态会得到改善,进而改善长期预后。因此,对70例严重缺血性左心室功能障碍(左心室射血分数<0.35)的患者进行了静息状态研究。然后,他们要么接受了血管重建术(n = 36),要么接受了药物治疗(n = 34)。54例患者存在存活心肌,16例不存在。平均21个月后对他们的左心室功能和几何形态(大小和形状)变化进行了评估。进行了平均3.5年的进一步随访以确定预后。存在存活心肌的患者不仅局部和整体功能得到改善,左心室几何形态(形状和大小)也得到改善,这与功能改善无关且是功能改善之外的额外改善。在长期随访中,左心室收缩末期容积的变化是15例死亡患者和55例未死亡患者之间唯一的多变量判别指标,无论他们是否接受了血管重建术。因此,评估慢性缺血性心脏病中存活心肌血管重建术的效果不仅应包括静息时局部和整体左心室功能的改善,还应包括左心室几何形态的改善。左心室几何形态的改善有助于更好的左心室收缩功能,而这反过来又是血管重建术后生存的最佳预测指标。