Imagawa H, Yoshino T, Kobayashi T, Matsumura R, Satoh H, Fudemoto Y, Nakano S
Department of Circulatory Dynamics, Center for Adult Diseases, Osaka, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1990 Apr;38(4):551-9.
The present study was designed to assess a left ventricular function following coronary artery bypass grafting (CABG) in patients with previous myocardial infarction (MI). The subject was consisted of 10 patients with MI (MI(+) group) and 6 without it (MI(-) group). Both groups underwent complete revascularization. Stroke index (SI), ejection fraction (EF), systolic pressure/end-systolic volume index (SP/ESVI) and end-diastolic volume index (EDVI) were evaluated utilizing radionuclide angiography at rest and during exercise (Ex) before and after CABG. The influence of size of myocardial infarction on left ventricular function were also analyzed. Preoperatively during Ex, EF showed decrease, SP/ESVI no change and EDVI increase in both MI(+) and MI(-) group compared with those at rest. Postoperatively during Ex, SI, EF and EDVI showed no change and SP/ESVI increase in both MI(+) and MI(-) group compared with those at rest. Ejection fraction and SP/ESVI during Ex in MI(+) group had significant differences compared with those in both MI(-) group and control group. Ejection fraction and SP/ESVI during Ex in MI(-) showed no difference compared with those in control group. The size of MI suggested by ECG scoring system (proposed by Wagner GS et al, Circulation '82) had negative correlations with both Ex-induced increment of postoperative EF and Ex-induced increase ratio of postoperative SP/ESVI. These data indicated that complete revascularization improved EF and SP/ESVI in patients with MI, and moreover normalized those in patients without MI. But in the case of extensive MI, even complete revascularization might not recover poor functional reserve during Ex.
本研究旨在评估既往有心肌梗死（MI）患者冠状动脉旁路移植术（CABG）后的左心室功能。研究对象包括10例心肌梗死患者（MI(+)组）和6例无心肌梗死患者（MI(-)组）。两组均接受了完全血运重建。在CABG前后，利用放射性核素血管造影术评估静息和运动（Ex）时的每搏输出量指数（SI）、射血分数（EF）、收缩压/舒张末期容积指数（SP/ESVI）和舒张末期容积指数（EDVI）。还分析了心肌梗死面积对左心室功能的影响。术前运动时，MI(+)组和MI(-)组的EF均下降，SP/ESVI无变化，EDVI增加，与静息时相比。术后运动时，MI(+)组和MI(-)组的SI、EF和EDVI均无变化，SP/ESVI增加，与静息时相比。MI(+)组运动时的射血分数和SP/ESVI与MI(-)组和对照组相比有显著差异。MI(-)组运动时的射血分数和SP/ESVI与对照组相比无差异。心电图评分系统（由Wagner GS等人于1982年提出，发表于《循环》杂志）提示的心肌梗死面积与术后运动诱导的EF增量和术后运动诱导的SP/ESVI增加率均呈负相关。这些数据表明，完全血运重建改善了心肌梗死患者的EF和SP/ESVI，而且使无心肌梗死患者的这些指标恢复正常。但在广泛心肌梗死的情况下，即使完全血运重建也可能无法恢复运动时较差的功能储备。
