Department of Cardiothoracic Surgery, Huashan Hospital of Fudan University, Shanghai, China.
Department of Echocardiography, Huashan Hospital of Fudan University, Shanghai, China.
Eur J Cardiothorac Surg. 2018 Jul 1;54(1):84-90. doi: 10.1093/ejcts/ezy024.
The aim of this study was to explore the predictors of the improvement in moderate ischaemic mitral regurgitation (IMR) after off-pump coronary artery bypass grafting (OPCAB) focusing on left ventricular (LV) dyssynchrony.
A prospective study was performed among 135 patients (age at surgery, mean ± SD: 67.0 ± 8.2 years, 33.3% women) with prior myocardial infarction and moderate IMR undergoing OPCAB from 2008 to 2015. Preoperative and follow-up clinical and echocardiographic parameters were analysed, focusing on LV global/regional dyssynchrony. Patients were grouped by IMR at 1 year postoperatively: improved group with no or mild IMR (n = 61) and failure group with moderate or severe IMR (n = 67). Data were compared between groups to explore the predictors of IMR improvement after OPCAB.
Seven patients who died before the 1-year postoperative assessment were excluded. At the 1-year follow up, there were 61 patients in the improved group and 67 patients in the failure group. Preoperatively, the improved group had smaller LV global dyssynchrony, LV regional dyssynchrony (papillary muscle systolic dyssynchrony; improved group versus failure group: 48.5 ± 4.5 ms vs 57.1 ± 3.9 ms; P < 0.001) and greater LV ejection fraction (improved group versus failure group: 44.7 ± 5.0% vs 36.7 ± 6.7%; P < 0.001) than the failure group. Papillary muscle systolic dyssynchrony (odds ratio 1.556, 95% confidence interval 1.313-1.845; P < 0.001) and preoperative ejection fraction (odds ratio 0.799, 95% confidence interval 0.691-0.924; P = 0.002) were independent predictors of moderate IMR improvement after OPCAB.
In the selected patients, preoperative moderate IMR could be relieved by coronary artery bypass grafting. Greater ejection fraction and absence of LV regional dyssynchrony may predict the improvement in moderate IMR after coronary artery bypass grafting, suggesting that LV dyssynchrony especially regional dyssynchrony and preserved ventricular function would be important to the outcome of patients with moderate IMR.
本研究旨在探讨非体外循环冠状动脉旁路移植术（OPCAB）后中度缺血性二尖瓣反流（IMR）改善的预测因素，重点关注左心室（LV）不同步性。
对 2008 年至 2015 年期间接受 OPCAB 的 135 例（手术时年龄，均值±标准差：67.0±8.2 岁，33.3%为女性）有先前心肌梗死和中度 IMR 的患者进行前瞻性研究。分析术前和随访的临床和超声心动图参数，重点关注 LV 整体/节段性不同步。根据术后 1 年时的 IMR 将患者分为两组：无或轻度 IMR 组（n=61）和中度或重度 IMR 组（n=67）。比较两组间数据，以探讨 OPCAB 后 IMR 改善的预测因素。
在术后 1 年的评估前，有 7 例患者死亡，被排除在外。在 1 年的随访中，改善组有 61 例，失败组有 67 例。术前，改善组的 LV 整体不同步性、LV 节段不同步性（乳头肌收缩不同步；改善组与失败组：48.5±4.5ms 比 57.1±3.9ms；P<0.001）和更高的 LV 射血分数（改善组与失败组：44.7±5.0%比 36.7±6.7%；P<0.001）均小于失败组。乳头肌收缩不同步（比值比 1.556，95%置信区间 1.313-1.845；P<0.001）和术前射血分数（比值比 0.799，95%置信区间 0.691-0.924；P=0.002）是 OPCAB 后中度 IMR 改善的独立预测因素。
在选择的患者中，冠状动脉旁路移植术可缓解术前中度 IMR。更高的射血分数和不存在 LV 节段性不同步可能预示着冠状动脉旁路移植术后中度 IMR 的改善，这表明 LV 不同步性（特别是节段性不同步性）和保留的心室功能对中度 IMR 患者的结局很重要。
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