Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea.
Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Korea.
J Thorac Cardiovasc Surg. 2020 May;159(5):1798-1805. doi: 10.1016/j.jtcvs.2019.04.109. Epub 2019 Jun 8.
Serial changes in segmental myocardial function after surgical myocardial revascularization have not been well demonstrated. This study was conducted to evaluate improvements in segmental myocardial function after coronary artery bypass grafting in patients with left ventricular dysfunction.
Serial cardiac magnetic resonance with late gadolinium enhancement (LGE) was performed in 67 patients with left ventricular ejection fraction ≤0.35, preoperatively and at 3 months and 1 year after surgery. The wall motion score and transmural extent of LGE were evaluated on a 16-segment model. Changes in segmental myocardial function were evaluated according to the transmurality of LGE (5-point scale: grade 0 = absence of LGE, 1 = LGE 1%-25%, 2 = LGE 26%-50%, 3 = LGE 51%-75%, and 4 = LGE 76%-100%).
Of 908 segments in which 1-year graft patency was confirmed, 657 dysfunctional segments (378 hypokinesia, 275 akinesia, 2 dyskinesia, and 2 aneurysm) were evaluated. The LGE grades were 0, 1, 2, 3, and 4 in 235, 187, 127, 59, and 49 segments, respectively. Segmental myocardial function improved in 56.5% (371 out of 657 segments) and 58.9% (387 out of 657 segments) of dysfunctional segments at 3 months and 1 year, respectively. Of LGE grades 0, 1, 2, 3, and 4 segments, improved wall motion was observed with an inverse correlation in 71.1% (167 out of 235 segments), 55.1% (103 out of 187 segments), 49.6% (63 out of 127 segments), 40.7% (24 out of 59 segments), and 28.6% (14 out of 49 segments) at 3 months and in 74.0% (174 out of 235 segments), 57.2% (107 out of 187 segments), 52.8% (67 out of 127 segments), 44.1% (26 out of 59 segments), and 26.5% (13 out of 49 segments) at 1 year, respectively.
One third of segments with a transmural extent of LGE >50% still had a chance for improvement after revascularization, although an inverse correlation was seen between the LGE grade and improvement of segmental myocardial function.
手术后节段性心肌功能的连续变化尚未得到很好的证明。本研究旨在评估左心室功能障碍患者冠状动脉旁路移植术后节段性心肌功能的改善情况。
对 67 例左心室射血分数≤0.35 的患者进行了心脏磁共振成像（CMR）检查，包括延迟钆增强（LGE），分别在术前和术后 3 个月和 1 年进行。通过 16 节段模型评估壁运动评分和 LGE 的透壁程度。根据 LGE 的透壁程度（5 分制：0 级=无 LGE，1 级=LGE 1%-25%，2 级=LGE 26%-50%，3 级=LGE 51%-75%，4 级=LGE 76%-100%）评估节段性心肌功能的变化。
在 908 个确认 1 年通畅的节段中，评估了 657 个功能障碍节段（378 个运动减弱，275 个运动消失，2 个运动障碍，2 个动脉瘤）。LGE 分级分别为 0、1、2、3 和 4 的节段分别为 235、187、127、59 和 49 个。在 3 个月和 1 年时，56.5%（371/657 个）和 58.9%（387/657 个）的功能障碍节段的节段性心肌功能得到改善。在 LGE 分级为 0、1、2、3 和 4 的节段中，在 3 个月时，71.1%（167/235 个）、55.1%（103/187 个）、49.6%（63/127 个）、40.7%（24/59 个）和 28.6%（14/49 个）的节段出现改善的壁运动，而在 1 年时，74.0%（174/235 个）、57.2%（107/187 个）、52.8%（67/127 个）、44.1%（26/59 个）和 26.5%（13/49 个）的节段出现改善的壁运动。
尽管 LGE 透壁程度>50%的节段与节段性心肌功能改善呈负相关，但仍有三分之一的节段有改善的机会。
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