应激多排螺旋 CT 测量的局部心肌血流作为冠状动脉旁路移植术后左心室功能恢复的预测指标。

Regional myocardial blood flow measured by stress multidetector computed tomography as a predictor of recovery of left ventricular function after coronary artery bypass grafting.

机构信息

Department of Cardiovascular Surgery, Ehime University, Japan.

出版信息

Am Heart J. 2010 Sep;160(3):528-34. doi: 10.1016/j.ahj.2010.06.026.

DOI:10.1016/j.ahj.2010.06.026

PMID:20826263

Abstract

BACKGROUND

Multidetector-row computed tomography (MDCT) applications have expanded to evaluation of myocardial blood flow (MBF) and viability. We quantified regional MBF pre- and post-coronary artery bypass grafting (CABG) using adenosine stress and cardiac 64-MDCT, and investigated whether the results predict MBF and left ventricular (LV) function recovery after CABG.

METHODS

We studied 321 regions in 19 CABG patients who underwent adenosine stress 64-row MDCT perfusion imaging and cine magnetic resonance imaging pre- and post-CABG. Myocardial blood flow was estimated from linear regression equation slopes using Patlak plot analyses and compared with LV function by measuring wall thickening (%WT) using cine magnetic resonance imaging.

RESULTS

Overall mean MBFs were 1.39 +/- 0.49 and 1.95 +/- 0.49 mL/(g min) pre- and post-CABG (P < .0001). Myocardial blood flow in revascularized areas increased significantly (pre-CABG 1.18 +/- 0.45, post-CABG 1.99 +/- 0.66 mL/[g min], P < .001), whereas nonischemic areas showed no difference (1.79 +/- 0.70 and 1.97 +/- 0.46 mL/[g min], P = .14). Revascularized areas with preoperative MBF > or = 0.9 mL/(g min) showed significantly greater MBF improvement than those with preoperative MBF <0.9 mL/(g min) (P = .04). In patients with preoperative LV dysfunction (ejection fraction <40%), %WT in revascularized areas with pre-CABG MBF > or = 0.9 mL/(g min) improved significantly after CABG (pre-%WT 40.9 +/- 22.9, post-%WT 52.8 +/- 20.6, P = .03) versus those with pre-CABG MBF <0.9 mL/(g min) (pre-%WT 53.2 +/- 35.5, post-%WT 42.5 +/- 17.0, P = .40).

CONCLUSIONS

Our results demonstrated more significantly increased MBF post-CABG than pre-CABG, particularly in revascularized areas. Regional MBF before CABG may predict MBF and LV function recovery, in the short term, after CABG.

摘要

背景

多排螺旋 CT（MDCT）的应用已经扩展到心肌血流（MBF）和存活能力的评估。我们使用腺苷应激和心脏 64-MDCT 对冠状动脉旁路移植术（CABG）前后的局部 MBF 进行定量，并研究结果是否可以预测 CABG 后 MBF 和左心室（LV）功能的恢复。

方法

我们研究了 19 名 CABG 患者的 321 个区域，这些患者在 CABG 前后接受了腺苷应激 64 排 MDCT 灌注成像和电影磁共振成像。使用 Patlak 图分析从线性回归方程斜率估计心肌血流，并通过测量电影磁共振成像中的壁增厚（%WT）来测量 LV 功能。

结果

总体平均 MBF 在 CABG 前后分别为 1.39 ± 0.49 和 1.95 ± 0.49 mL/（g min）（P <.0001）。再血管化区域的心肌血流显著增加（CABG 前 1.18 ± 0.45，CABG 后 1.99 ± 0.66 mL/（g min），P <.001），而非缺血区域无差异（1.79 ± 0.70 和 1.97 ± 0.46 mL/（g min），P =.14）。术前 MBF >或= 0.9 mL/（g min）的再血管化区域的 MBF 改善明显大于术前 MBF <0.9 mL/（g min）的区域（P =.04）。在术前 LV 功能障碍（射血分数<40%）的患者中，CABG 后再血管化区域的 CABG 前 MBF >或= 0.9 mL/（g min）的 %WT 明显改善（CABG 前 %WT 40.9 ± 22.9，CABG 后 %WT 52.8 ± 20.6，P =.03），而 CABG 前 MBF <0.9 mL/（g min）的患者（CABG 前 %WT 53.2 ± 35.5，CABG 后 %WT 42.5 ± 17.0，P =.40）。