通过磁共振成像识别的心肌瘢痕可预测冠状动脉搭桥术后左心室功能的改善。

Myocardial scar identified by magnetic resonance imaging can predict left ventricular functional improvement after coronary artery bypass grafting.

作者信息

Yang Tao, Lu Min-Jie, Sun Han-Song, Tang Yue, Pan Shi-Wei, Zhao Shi-Hua

机构信息

Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital and Cardiovascular Institute, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.

Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital and Cardiovascular Institute, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.

出版信息

PLoS One. 2013 Dec 16;8(12):e81991. doi: 10.1371/journal.pone.0081991. eCollection 2013.

BACKGROUND

Previous studies have shown that viable myocardium predicts recovery of left ventricular (LV) dysfunction after revascularization. Our aim was to evaluate the prognostic value of myocardial scar assessed by late gadolinium-enhanced cardiovascular magnetic resonance imaging (LGE-CMR) on functional recovery in patients undergoing coronary artery bypass grafting (CABG).

METHODS

From November 2009 to September 2012, 63 patients with reduced left ventricular ejection fraction (LVEF) referred for first-time isolated CABG were prospectively enrolled, 52 were included in final analysis. LV functional parameters and scar tissue were assessed by LGE-CMR at baseline and 6 months after surgery. Patency of grafts was evaluated by computed tomography angiography (CTA) 6 months post-CABG. Predictors for global functional recovery were analyzed.

RESULTS

The baseline LVEF was 32.7 ± 9.2%, which improved to 41.6 ± 11.0% 6 months later and 32/52 patients improved LVEF by ≥ 5%. Multivariate logistic regression analysis showed that the most significant negative predictor for global functional recovery was the number of scar segments (Odds ratio 2.864, 95% Confidence Interval 1.172-6.996, p = 0.021). Receiver-Operator-Characteristic (ROC) analysis demonstrated that ≤ 4 scar segments predicted global functional recovery with a sensitivity and specificity of 85.0% and 87.5%, respectively (AUC = 0.91, p<0.001). Comparison of ROC curves also indicated that scar tissue was superior to viable myocardium in predicting cardiac functional recovery (p<0.001).

CONCLUSIONS

Our findings indicated that scar tissue on LGE-CMR is an independent negative predictor of cardiac functional recovery in patients with impaired LV function undergoing CABG. These observations may be helpful for clinicians and cardiovascular surgeons to determine which patients are most likely to benefit from surgical revascularization.

背景

既往研究表明，存活心肌可预测血运重建后左心室（LV）功能障碍的恢复情况。我们的目的是评估通过延迟钆增强心血管磁共振成像（LGE-CMR）评估的心肌瘢痕对接受冠状动脉旁路移植术（CABG）患者功能恢复的预后价值。

方法

2009年11月至2012年9月，前瞻性纳入63例首次因左心室射血分数（LVEF）降低而接受单纯CABG的患者，最终52例纳入分析。在基线和术后6个月通过LGE-CMR评估左心室功能参数和瘢痕组织。在CABG术后6个月通过计算机断层血管造影（CTA）评估移植血管通畅情况。分析整体功能恢复的预测因素。

结果

基线LVEF为32.7±9.2%，6个月后改善至41.6±11.0%，52例患者中有32例LVEF改善≥5%。多因素逻辑回归分析显示，对整体功能恢复最显著的负性预测因素是瘢痕节段数（比值比2.864，95%置信区间1.172 - 6.996，p = 0.021）。受试者工作特征（ROC）分析表明，≤4个瘢痕节段预测整体功能恢复的敏感性和特异性分别为85.0%和87.5%（曲线下面积 = 0.91，p<0.001）。ROC曲线比较还表明，瘢痕组织在预测心脏功能恢复方面优于存活心肌（p<0.001）。