Velinović Milos, Kocica Mladen, Vranes Mile, Mikić Aleksandar, Vukomanović Vlada, Davidović Lazar, Obrenović-Krićanski Biljana, Cvetkovic Slobodan, Soski Ljiljana, Ristić Arsen D
Srp Arh Celok Lek. 2005 Sep-Oct;133(9-10):406-11. doi: 10.2298/sarh0510406v.
Patients suffering from chronic ischaemic cardiomyopathy and left ventricular ejection fraction (LVEF) lower than 30% represent a difficult and controversial population for surgical treatment.
The aim of this study was to evaluate the effects of surgical treatment on the early and long-term outcome of these patients.
The patient population comprised 50 patients with LVEF < 30% (78% male, mean age: 58.3 years, range: 42-75 years) who underwent surgical myocardial revascularisation during the period 1995-2000. Patients with left ventricular aneurysms or mitral valve insufficiency were excluded from the study. The following echocardiography parameters were evaluated as possible prognostic indicators: LVEF, fraction of shortening (FS), left ventricular systolic and diastolic diameters (LVEDD, LVESD) and volumes (LVEDV, LVESV), as well as their indexed values (LVESVI).
Fifteen patients (30%) died during the follow-up, 2/50 intraoperatively (4%). The presence of diabetes mellitus, previous myocardial infarction, main left coronary artery disease, and three-vessel disease, correlated significantly with the surgical outcomes. The patient's age, family history, smoking habits, hypertension, hyperlipidaemia, history of stroke, peripheral vascular disease, and renal failure, did not correlate with the mortality rate. A comparison of preoperative echocardiography parameters between survivors and non-survivors revealed significantly divergent LVEF, LVEDD, LVESD, LVEDV, LVESV, and LVESVI values. Preoperative LVESVI offered the highest predictive value (R = 0.595).
Diabetes mellitus, history of myocardial infarction, stenosis of the main branch, and three-vessel disease, significantly affected the perioperative and long-term outcome of surgical revascularisation in patients with ischaemic cardiomyopathy and LVEF < 30%. In survivors, LVEF, FS, and systolic and diastolic echocardiography parameters, as well as their indexed values, significantly improved after surgical revascularisation. LVESVI provided the highest predictive value for mortality.
患有慢性缺血性心肌病且左心室射血分数（LVEF）低于30%的患者是外科治疗的一个困难且存在争议的群体。
本研究的目的是评估外科治疗对这些患者早期和长期预后的影响。
研究对象包括50例LVEF<30%的患者（78%为男性，平均年龄：58.3岁，范围：42 - 75岁），这些患者在1995年至2000年期间接受了外科心肌血运重建术。左心室室壁瘤或二尖瓣关闭不全的患者被排除在研究之外。以下超声心动图参数被评估为可能的预后指标：LVEF、缩短分数（FS）、左心室收缩和舒张直径（LVEDD、LVESD）及容积（LVEDV、LVESV），以及它们的指数值（LVESVI）。
15例患者（30%）在随访期间死亡，其中2例（4%）死于术中。糖尿病、既往心肌梗死、左冠状动脉主干病变和三支血管病变与手术结果显著相关。患者的年龄、家族史、吸烟习惯、高血压、高脂血症、中风史、外周血管疾病和肾衰竭与死亡率无关。对幸存者和非幸存者术前超声心动图参数的比较显示，LVEF、LVEDD、LVESD、LVEDV、LVESV和LVESVI值存在显著差异。术前LVESVI具有最高的预测价值（R = 0.595）。
糖尿病、心肌梗死病史、主要分支狭窄和三支血管病变显著影响缺血性心肌病且LVEF<30%患者外科血运重建术的围手术期和长期预后。在幸存者中，外科血运重建术后LVEF、FS以及收缩和舒张期超声心动图参数及其指数值均有显著改善。LVESVI对死亡率具有最高的预测价值。
