Bezmialem Foundation University, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey.
Clinics (Sao Paulo). 2013 Oct;68(10):1333-7. doi: 10.6061/clinics/2013(10)07.
Successful revascularization of chronic total occlusions has been associated with improved left ventricular systolic function, reduced anginal symptoms, increased exercise capacity, and increased survival. This study was conducted to determine the impact of revascularization in chronic total occlusion on left ventricular function using novel echocardiographic techniques.
A total of 129 patients with chronic total occlusion who underwent revascularization between April 2011 and November 2012 were included in this study. Echocardiographic assessments with two-dimensional speckle tracking echocardiography and real-time three-dimensional echocardiography were performed before the procedure and one month after the procedure. The left ventricular ejection fraction, left ventricular volumes, and three-dimensional systolic dyssynchrony index were quantified.
An immediate procedural success was obtained in 118 patients (91.5%). There were no acute or subacute stent thromboses during follow-up. The mean left ventricular ejection fraction significantly increased (p<0.001), while the left ventricular end-diastolic and end-systolic volumes significantly decreased (p = 0.001 and p<0.001, respectively). The three-dimensional systolic dyssynchrony index also decreased significantly (p<0.001). The global longitudinal strain showed a significant increase after successful revascularization (p<0.001). An increase in the global longitudinal strain was correlated with an increase in the left ventricular ejection fraction (r = 0.27, p = 0.02). The patients with a left ventricular ejection fraction ≥50% displayed a greater improvement in the global longitudinal strain, and the patients with diabetes showed less improvement.
Using novel echocardiographic techniques, our results showed that restoring the coronary blood flow in chronic total occlusion patients reduces the left ventricular volumes and improves the left ventricular ejection fraction and the global longitudinal strain of hibernating myocardium.
慢性完全闭塞血管的血运重建与左心室收缩功能的改善、心绞痛症状的减轻、运动能力的提高和生存率的提高有关。本研究旨在使用新型超声心动图技术来确定慢性完全闭塞血管血运重建对左心室功能的影响。
共纳入 129 例 2011 年 4 月至 2012 年 11 月接受血运重建的慢性完全闭塞患者。术前和术后 1 个月进行二维斑点追踪超声心动图和实时三维超声心动图评估。定量分析左心室射血分数、左心室容积和三维收缩不同步指数。
118 例（91.5%）患者即刻手术成功。随访期间无急性或亚急性支架内血栓形成。左心室射血分数显著增加（p<0.001），左心室舒张末期和收缩末期容积显著减少（p=0.001 和 p<0.001）。三维收缩不同步指数也显著降低（p<0.001）。成功血运重建后，整体纵向应变明显增加（p<0.001）。整体纵向应变的增加与左心室射血分数的增加相关（r=0.27，p=0.02）。左心室射血分数≥50%的患者整体纵向应变改善更大，糖尿病患者改善较小。
使用新型超声心动图技术，我们的结果表明，恢复慢性完全闭塞患者的冠状动脉血流可减少左心室容积，提高左心室射血分数和冬眠心肌的整体纵向应变。
