Kirschbaum Sharon W, Baks Timo, van den Ent Martin, Sianos George, Krestin Gabriel P, Serruys Patrick W, de Feyter Pim J, van Geuns Robert-Jan M
Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
Am J Cardiol. 2008 Jan 15;101(2):179-85. doi: 10.1016/j.amjcard.2007.07.060. Epub 2007 Dec 3.
We investigated early and late effects of percutaneous revascularization for chronic total coronary occlusion on left ventricular (LV) function and volumes. Magnetic resonance imaging was performed in 21 patients before and 5 months and 3 years after recanalization. Global LV function and volumes and segmental wall thickening (SWT) were quantified on cine images. The 2 viability indexes used were the transmural extent of infarction (TEI) on delayed contrast enhancement images and end-diastolic wall thickness at baseline. Significant decreases in mean end-diastolic (86 +/- 14 to 78 +/- 15 ml/m2; p = 0.02) and mean end-systolic volume indexes (35 +/- 13 to 30 +/- 13 ml/m2; p = 0.03) were observed 3 years after recanalization. Mean ejection fraction tended to improve (60 +/- 9% to 63 +/- 11%; p = 0.11). SWT significantly increased at 5-months' follow-up (p <0.001), and an additional improvement was found at 3 years' (p = 0.04) follow-up in segments with TEI <25%. In segments with TEI of 25% to 75%, SWT was unchanged at 5-month follow-up (p = 0.89), but improved at 3 years (p = 0.04). SWT was unchanged in segments with transmural scars. For segmental functional recovery, TEI was a better predictor than end-diastolic wall thickness at baseline (odds ratio 5.6, 95% confidence interval 1.5 to 21.1, p = 0.01 vs odds ratio 2.5, 95% confidence interval 0.7 to 8.3, p = 0.14). In conclusion, a positive effect on LV remodeling and ejection fraction was observed up to 3 years after recanalization. Both early and late improvements in regional LV function were observed in the perfusion territory of chronic total coronary occlusion and were related to the transmural extent of infarction on pretreatment magnetic resonance imaging.
我们研究了经皮血管重建术治疗慢性完全性冠状动脉闭塞对左心室（LV）功能和容积的早期及晚期影响。对21例患者在再通术前、术后5个月和3年进行了磁共振成像检查。在电影图像上对左心室整体功能、容积及节段性室壁增厚（SWT）进行定量分析。所使用的2个存活指标分别为延迟对比增强图像上的梗死透壁范围（TEI）和基线时的舒张末期室壁厚度。再通术后3年，平均舒张末期容积指数（从86±14降至78±15 ml/m²；p = 0.02）和平均收缩末期容积指数（从35±13降至30±13 ml/m²；p = 0.03）显著降低。平均射血分数有改善趋势（从60±9%提高到63±11%；p = 0.11）。SWT在随访5个月时显著增加（p <0.001），在TEI<25%的节段，随访3年时又有进一步改善（p = 0.04）。在TEI为25%至75%的节段，随访5个月时SWT无变化（p = 0.89），但在3年时有所改善（p = 0.04）。透壁性瘢痕节段的SWT无变化。对于节段性功能恢复，TEI比基线时的舒张末期室壁厚度是更好的预测指标（优势比5.6，95%置信区间1.5至21.1，p = 0.01；相比之下优势比2.5，95%置信区间0.7至8.3，p = 0.14）。总之，再通术后3年观察到对左心室重构和射血分数有积极影响。在慢性完全性冠状动脉闭塞的灌注区域观察到左心室局部功能的早期和晚期改善，且与术前磁共振成像上的梗死透壁范围有关。
