Maruskova Michaela, Gregor Pavel, Bartunek Jozef, Tintera Jaroslav, Penicka Martin
Department of Cardiology, 3rd Faculty of Medicine, Cardiocenter, Charles University, Prague, Czech Republic.
J Thorac Cardiovasc Surg. 2009 Jul;138(1):62-8. doi: 10.1016/j.jtcvs.2008.11.040. Epub 2009 Feb 7.
Myocardial viability and left ventricular dyssynchrony are important predictors of long-term outcomes in patients with ischemic left ventricular dysfunction. The objective of this study was to test the hypothesis that assessment of myocardial viability and left ventricular dyssynchrony will predict perioperative mortality in high-risk patients with ischemic left ventricular dysfunction having coronary artery bypass surgery.
The study consisted of 79 consecutive patients with ischemic cardiomyopathy (age 65 +/- 9 years; 81% men; ejection fraction 30% +/- 6%) and logistic European system for cardiac operative risk evaluation > 10% having coronary artery bypass surgery. Myocardial viability was assessed by delayed contrast-enhanced magnetic resonance imaging. Left ventricular dyssynchrony was calculated using tissue Doppler from measurements of regional electromechanical coupling times in left ventricular basal segments before coronary artery bypass surgery.
Twenty (25.3%) patients died within 30 days following coronary artery bypass surgery. Survivors (n = 59) showed a larger extent of viable myocardium (6.9 +/- 3.6 viable segments vs 3.4 +/- 3.3 viable segments, P < .001) and smaller left ventricular dyssynchrony (75 +/- 5 ms vs 179 +/- 83 ms, P < .001) than nonsurvivors. The presence of significant dyssynchrony (>or=105 ms) and absence of myocardial viability (<5 viable segments) independently predicted 30-day mortality with hazard ratio 3.26, 95% confidence interval 1.61 to 8.33 (P < .01) and hazard ratio 1.72, 95% confidence interval 1.59 to 1.89 (P < .01), respectively. All but 2 patients (94.1%) with viable myocardium and without left ventricular dyssynchrony survived coronary artery bypass surgery as compared with only 12 (52.2%) patients with nonviable myocardium and severe dyssynchrony (P < .001).
In high-risk patients with ischemic left ventricular dysfunction having coronary artery bypass surgery, both myocardial viability and left ventricular dyssynchrony are important predictors of perioperative outcome. Assessment of myocardial viability and left ventricular dyssynchrony should be a routine part of the preoperative evaluation of these patients.
心肌存活性和左心室不同步是缺血性左心室功能障碍患者长期预后的重要预测指标。本研究的目的是检验如下假设：评估心肌存活性和左心室不同步将预测接受冠状动脉搭桥手术的高危缺血性左心室功能障碍患者的围手术期死亡率。
本研究纳入了79例连续的缺血性心肌病患者（年龄65±9岁；81%为男性；射血分数30%±6%），其欧洲心脏手术风险评估系统逻辑分析值>10%，均接受冠状动脉搭桥手术。通过延迟对比增强磁共振成像评估心肌存活性。在冠状动脉搭桥手术前，利用组织多普勒根据左心室基底节段区域机电耦合时间的测量值计算左心室不同步。
20例（25.3%）患者在冠状动脉搭桥手术后30天内死亡。与未存活者相比，存活者（n = 59）显示出更大范围的存活心肌（存活节段6.9±3.6个 vs 3.4±3.3个，P <.001）和更小的左心室不同步（75±5毫秒 vs 179±83毫秒，P <.001）。显著不同步（≥105毫秒）的存在和心肌存活性的缺失（<5个存活节段）分别独立预测30天死亡率，风险比为3.26，95%置信区间为1.61至8.33（P <.01）和风险比为1.72，95%置信区间为1.59至1.89（P <.01）。除2例患者外（94.1%），有存活心肌且无左心室不同步的患者冠状动脉搭桥手术后存活，而仅有12例（52.2%）有非存活心肌且严重不同步的患者存活（P <.001）。
在接受冠状动脉搭桥手术的高危缺血性左心室功能障碍患者中，心肌存活性和左心室不同步都是围手术期结局的重要预测指标。评估心肌存活性和左心室不同步应成为这些患者术前评估的常规部分。
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