Thielmann Matthias, Hunold Peter, Böhm Claudia, Massoudy Parwis, Jakob Heinz
Department of Thoracic and Cardiovascular Surgery, West-German Heart Center, University Hospital Essen, Essen, Germany.
Vasc Health Risk Manag. 2007;3(5):763-8.
In the present study, patients with severely compromized left ventricular function underwent magnetic resonance imaging (MRI) before and after coronary artery bypass grafting (CABG). Although improvement of global myocardial contractile function has been shown before, we sought to evaluate whether a functional contractile improvement may be determinable on a myocardial segmental basis after CABG surgery.
Thirty-three CABG patients with left ventricular ejection fraction (LVEF) < or =30% prospectively underwent MRI to compare pre- and postoperative functional data. At follow-up, all survivors underwent clinical assessment. In 16 patients (three patients died perioperatively, 13 could were lost to MRI follow-up because of cardiac resynchronization therapy and other reasons) postoperative MRI scanning was performed.
In-hospital mortality was 9%. At 20 +/- 2 months after surgery, New York Heart Association class improved from 3.0 +/- 0.1 to 2.2 +/- 0.2 (p < 0.01). Left ventricular end-diastolic volumes decreased significantly from 229 +/- 14 mL to 189 +/- 19 mL (p < 0.05). LV end-systolic volumes decreased significantly from 163 +/- 13 mL to 126 +/- 17 mL (p < 0.05). LVEF improved from 30 +/- 2% to 36 +/- 3% (p < 0.05). On a segmental basis, 42 out of 875 segments (4.8%) had normal function before surgery, at follow-up, 177 segments (20.4%) had normal regional function (p < 0.05).
Patients who undergo CABG surgery with severely compromized left ventricular function, postoperative MRI shows improved global and segmental cardiac function at mid-term follow-up. At the same time there is considerable clinical improvement.
在本研究中，左心室功能严重受损的患者在冠状动脉旁路移植术（CABG）前后接受了磁共振成像（MRI）检查。尽管之前已显示整体心肌收缩功能有所改善，但我们试图评估CABG手术后心肌节段水平上是否可确定功能性收缩改善情况。
33例左心室射血分数（LVEF）≤30%的CABG患者前瞻性地接受了MRI检查，以比较术前和术后的功能数据。随访时，所有幸存者均接受临床评估。16例患者（3例围手术期死亡，13例因心脏再同步治疗及其他原因未能接受MRI随访）接受了术后MRI扫描。
住院死亡率为9%。术后20±2个月，纽约心脏协会心功能分级从3.0±0.1改善至2.2±0.2（p<0.01）。左心室舒张末期容积从229±14 mL显著降至189±19 mL（p<0.05）。左心室收缩末期容积从163±13 mL显著降至126±17 mL（p<0.05）。LVEF从30±2%提高至36±3%（p<0.05）。在节段水平上，术前875个节段中有42个（4.8%）功能正常，随访时，177个节段（20.4%）区域功能正常（p<0.05）。
接受CABG手术且左心室功能严重受损的患者，术后MRI显示中期随访时整体和节段性心功能均有改善。同时临床也有显著改善。
