冠状动脉搭桥术后心肌存活性与左心室功能改善及心力衰竭症状之间的关系。

Relationship between myocardial viability and improvement in left ventricular function and heart failure symptoms after coronary artery bypass surgery.

作者信息

Peovska I, Maksimovic J, Vavlukis M, Davceva J, Pop Gorceva D, Majstorov V, Kostova N, Bosevski M

机构信息

Heart Diseases Institute, Clinical Centre, Skopje, R. Macedonia.

出版信息

Prilozi. 2007 Jul;28(1):97-112.

PMID:17921921

Abstract

BACKGROUND

The evaluation of myocardial viability is an important preoperative parameter, predictive of improvement in regional and global left ventricular (LV) function after coronary artery bypass surgery (CABG). However, whether the presence of viability is also associated with relief of heart failure symptoms after revascularization is not always certain. The aims of the study were to define the relationship between extent of viable myocardium and improvement in LV function after CABG and to determine whether preoperative viability testing can predict improvement in heart failure symptoms.

METHODS

Eighty-five consecutive patients with ischemic cardiomyopathy (mean LVEF 35%) undergoing surgical revascularization were studied with a Tc-99m sestamibi one-day rest/nitrate enhanced myocardial perfusion SPECT imaging (MPI) to assess viability. Regional and global function were measured before and 16 -/+ 6 months after revascularization. We have used the Bull's eye quantitative analysis of MPI scans and 17 segment model of LV function and perfusion evaluation. Heart failure symptoms were graded according to the New York Heart Association (NYHA) criteria, before and 16 -/+ 6 months after revascularization.

RESULTS

The number of viable segments per patient was directly related to the improvement in LVEF after revascularization (r 0.79, P < 0.01). Patients with > 4 viable segments representing 24% of the left ventricle yielded the sensitivity of 83% and specificity of 79% respectively for predicting improvement in LVEF. Furthermore, the presence of four or more viable segments predicted improvement in heart failure symptoms after revascularization, with positive and negative predictive values of 79% and 74%, respectively.

CONCLUSION

The presence of substantial viability (four or more viable segments, 24% of the left ventricle) on myocardial perfusion gated SPECT imaging in patients with ischemic heart failure before CABG surgery has significant correlation with the improvement in LVEF and heart failure symptoms postoperatively.

摘要

背景

心肌存活性评估是一项重要的术前参数，可预测冠状动脉搭桥手术（CABG）后左心室（LV）局部和整体功能的改善。然而，心肌存活性的存在是否也与血运重建后心力衰竭症状的缓解相关并不总是确定的。本研究的目的是明确CABG后存活心肌范围与LV功能改善之间的关系，并确定术前存活性检测能否预测心力衰竭症状的改善。

方法

连续纳入85例缺血性心肌病患者（平均左心室射血分数[LVEF]为35%），接受手术血运重建，采用锝-99m甲氧基异丁基异腈一日静息/硝酸盐增强心肌灌注单光子发射计算机断层显像（SPECT）成像（MPI）评估心肌存活性。在血运重建前及术后16±6个月测量局部和整体功能。我们使用了MPI扫描的靶心定量分析以及LV功能和灌注评估的17节段模型。根据纽约心脏协会（NYHA）标准对血运重建前及术后16±6个月的心力衰竭症状进行分级。