Monsefi N, Zierer A, Bakhtiary F, Vogl Th, Ackermann H, Kleine P, Moritz A, Dzemali O
Department of Thoracic and Cardiovascular Surgery, J. W. Goethe University, Frankfurt am Main, Germany.
J Cardiovasc Surg (Torino). 2012 Aug;53(4):545-52.
The present study investigates the geometry of failing left ventricles with a special focus on apical deformation. A new surgical remodelling technique is evaluated.
In 124 patients with impaired left ventricular function (EF<40%) undergoing coronary artery bypass grafting (CABG) left ventricular (LV) geometry was evaluated by MRI scanning before and after surgery. Besides the sphericity index (SI) two further indices were calculated, longitudinal EF (LEF) and an apical conicity index (ACI). The results were compared to 15 patients with coronary heart disease and normal LV function and 10 test persons. In 35 patients with impaired LV function perpendicular apical compression (AC) stitches were placed.
In failing left ventricles indexed LV length increased (5.3 ± 0.6 cm/m2 vs. 4.7 ± 0.8 cm/m2 in control patients and 4.6 ± 0.3 cm/m2 in test persons, P=0.03). LEF was reduced (6% ± 4 versus 22% ± 6 and 19% ± 7 P=0.04). The classical SI was 0.56 ± 0.06 in heart failure patients, 0.50 ± 0.05 in control patients and 0.48 ± 0.04 in test persons. The ACI were 0.75 ± 0.06, 0.58 ± 0.06 and 0.57 ± 0.04 respectively (P<0.05), indicating a pronounced dilatation at the apex. After apical compression LEF improved to 15 ± 1%, the ACI to 0.64 ± 0.04 (P=0.04). LVEDV (166 ± 11 mL [AC] vs. 196 ± 14 mL [without AC]) as well as LV-EF (48 ± 3% [AC] vs. 36 ± 2% [without AC]) significantly improved only after remodelling (P<0.05).
Apical compression improved ventricular geometry and ventricular function in patients with dialatation of the left ventricular apex.
本研究调查左心室功能衰竭时的几何形态，特别关注心尖部变形情况。对一种新的手术重塑技术进行评估。
在124例左心室功能受损（射血分数<40%）且接受冠状动脉旁路移植术（CABG）的患者中，术前及术后通过MRI扫描评估左心室（LV）几何形态。除球形指数（SI）外，还计算了另外两个指标，纵向射血分数（LEF）和心尖圆锥指数（ACI）。将结果与15例冠心病且左心室功能正常的患者及10名测试对象进行比较。在35例左心室功能受损的患者中放置了垂直心尖部压迫（AC）缝线。
在左心室功能衰竭患者中，左心室长度指数增加（5.3±0.6 cm/m²，对照组患者为4.7±0.8 cm/m²，测试对象为4.6±0.3 cm/m²，P = 0.03）。LEF降低（6%±4，对照组为22%±6，测试对象为19%±7，P = 0.04）。心力衰竭患者的经典SI为0.56±0.06，对照组患者为0.50±0.05，测试对象为0.48±0.04。ACI分别为0.75±0.06、0.58±0.06和0.57±0.04（P<0.05），表明心尖部有明显扩张。心尖部压迫后，LEF改善至15±1%，ACI改善至0.64±0.04（P = 0.选择项）。仅在重塑后，左心室舒张末期容积（166±11 mL[AC]对196±14 mL[无AC]）以及左心室射血分数（48±3%[AC]对36±2%[无AC]）显著改善（P<0.05）。
心尖部压迫改善了左心室心尖部扩张患者的心室几何形态和心室功能。
