Eckardt Rozy, Kjeldsen Bo Juel, Johansen Allan, Grupe Peter, Haghfelt Torben, Thayssen Per, Andersen Lars Ib, Hesse Birger
Department of Cardiothoracic Surgery, Institute of Clinical Research, Odense University Hospital, Odense, Denmark.
Interact Cardiovasc Thorac Surg. 2012 Jun;14(6):779-84. doi: 10.1093/icvts/ivs099. Epub 2012 Apr 2.
OBJECTIVES We wanted to evaluate whether preoperative myocardial perfusion scintigraphy (MPS) could predict changes in cardiac symptoms and postoperative myocardial perfusion and left ventricular function after coronary artery bypass grafting (CABG). METHODS Ninety-two patients with stable angina pectoris (and at least one occluded coronary artery) underwent MPS before, and 6 months after, undergoing CABG. The result of the MPS was kept secret from the surgeons. RESULTS Before CABG, 90% of the patients had angina. After CABG, 97% of the patients were without symptoms. Overall graft patency was 84%. Before CABG, one patient had normal perfusion; in the rest of them the defects were classified as follows: reversible (60%), partly reversible (27%) and irreversible (12%). Following CABG, 33% had normal perfusion; in the rest the defects were reversible in 29%, partly reversible in 12% and irreversible in 26%. Left ventricular ejection fraction (LVEF), which was normal before operation in 45%, improved in 40% of all patients. The increase in LVEF was not related to the preoperative pattern of perfusion defects. Of 30 patients with normalized perfusion after CABG, 29 (97%) had reversible defects and one patient had partly reversible defects. Of 83 perfusion defects, which were normalized after CABG, 67 were reversible (81%) or partly reversible (12%). Seventy-five percent of all reversible coronary artery territories before CABG were normalized after operation. CONCLUSIONS Our results indicate that reversible or partly reversible perfusion defects at a preoperative MPS have a high chance of normalized myocardial perfusion assessed by MPS 6 months after operation. Normal perfusion is obtained almost exclusively in territories with reversible ischaemia. Symptoms improved in nearly all patients and LVEF in a significant fraction of the patients, not related to preoperative MPS.
目的 我们希望评估术前心肌灌注显像（MPS）能否预测冠状动脉旁路移植术（CABG）后心脏症状的变化、术后心肌灌注及左心室功能。方法 92例稳定型心绞痛患者（至少有一支冠状动脉闭塞）在接受CABG前及术后6个月接受了MPS检查。MPS结果对手术医生保密。结果 CABG术前，90%的患者有胸痛症状。CABG术后，97%的患者无症状。总体移植血管通畅率为84%。CABG术前，1例患者灌注正常；其余患者的缺损分类如下：可逆性（60%）、部分可逆性（27%）和不可逆性（12%）。CABG术后，33%的患者灌注正常；其余患者中，缺损为可逆性的占29%，部分可逆性的占12%，不可逆性的占26%。左心室射血分数（LVEF）术前正常者占45%，所有患者中有40%的患者LVEF有所改善。LVEF的增加与术前灌注缺损模式无关。CABG术后灌注正常的30例患者中，29例（97%）有可逆性缺损，1例患者有部分可逆性缺损。CABG术后灌注缺损恢复正常的83例中，67例为可逆性（81%）或部分可逆性（12%）。CABG术前所有可逆性冠状动脉供血区域中，75%术后灌注恢复正常。结论 我们的结果表明，术前MPS显示的可逆性或部分可逆性灌注缺损，术后6个月MPS评估时心肌灌注恢复正常的可能性很大。几乎仅在有可逆性缺血的区域获得正常灌注。几乎所有患者症状改善，相当一部分患者LVEF改善，且与术前MPS无关。
