Penicka Martin, Linkova Hana, Lang Otto, Fojt Richard, Kocka Viktor, Vanderheyden Marc, Bartunek Jozef
Department of Cardiology, Third Faculty of Medicine Charles University in Prague, Ruska 87, 10004 Prague, Czech Republic.
Circulation. 2009 Oct 13;120(15):1474-81. doi: 10.1161/CIRCULATIONAHA.108.842104. Epub 2009 Sep 28.
The persistence of moderate ischemic mitral regurgitation (IMR) after isolated coronary artery bypass graft surgery is an important independent predictor of long-term mortality. The aim of the present study was to identify predictors of postoperative improvement in moderate IMR in patients with ischemic heart disease undergoing elective isolated coronary artery bypass graft surgery.
The study population consisted of 135 patients with ischemic heart disease (age, 65+/-9 years; 81% male) and moderate IMR undergoing isolated coronary artery bypass graft surgery. Fourteen patients died before the 12-month follow-up echocardiography and were excluded. At the 12-month follow-up, 57 patients showed no or mild IMR (improvement group), whereas 64 patients failed to improve (failure group). Before coronary artery bypass graft surgery, the improvement group had significantly more viable myocardium and less dyssynchrony between papillary muscles than the failure group (P<0.001). All other preoperative parameters were similar in both groups. Large extent (> or =5 segments) of viable myocardium (odds ratio, 1.45; 95% confidence interval, 1.22 to 1.89; P<0.001) and absence (<60 ms) of dyssynchrony (odds ratio, 1.49; 95% confidence interval, 1.29 to 1.72; P<0.001) were independently associated with improvement in IMR. The majority (93%) of patients with viable myocardium and an absence of dyssynchrony showed an improvement in IMR. In contrast, only 34% and 18% of patients with dyssynchrony and nonviable myocardium, respectively, showed an improvement in IMR, whereas 32% and 49%, respectively, of these patients showed worsening of IMR (P<0.001).
Reliable improvement in moderate IMR by isolated coronary artery bypass graft surgery was observed only in patients with concomitant presence of viable myocardium and absence of dyssynchrony between papillary muscles.
单纯冠状动脉搭桥手术后中度缺血性二尖瓣反流（IMR）持续存在是长期死亡率的重要独立预测因素。本研究的目的是确定接受择期单纯冠状动脉搭桥手术的缺血性心脏病患者术后中度IMR改善的预测因素。
研究人群包括135例缺血性心脏病患者（年龄65±9岁；81%为男性），均患有中度IMR并接受单纯冠状动脉搭桥手术。14例患者在12个月随访超声心动图检查前死亡并被排除。在12个月随访时，57例患者IMR无或轻度反流（改善组），而64例患者未改善（未改善组）。冠状动脉搭桥手术前，改善组存活心肌明显多于未改善组，乳头肌间不同步性小于未改善组（P<0.001）。两组所有其他术前参数相似。大面积（≥5节段）存活心肌（比值比，1.45；95%置信区间，1.22至1.89；P<0.001）和无不同步性（<60毫秒）（比值比，1.49；95%置信区间，1.29至1.72；P<0.001）与IMR改善独立相关。大多数（93%）有存活心肌且无不同步性的患者IMR得到改善。相比之下，分别只有34%和18%有不同步性和无存活心肌的患者IMR得到改善，而这些患者中分别有32%和49%的患者IMR恶化（P<0.001）。
仅在伴有存活心肌且乳头肌间无不同步性的患者中，观察到单纯冠状动脉搭桥手术能使中度IMR可靠改善。
