Cao J, Dang H M, Song Y, Wu L S, Liu D, Huang Q, Dong R
Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Zhonghua Yi Xue Za Zhi. 2020 May 12;100(18):1380-1384. doi: 10.3760/cma.j.cn112137-20191218-02768.
To explore the impact of left ventricle remodeling on perioperative risk and short-term survival in patients with heart failure and reduced ejection fraction (HFrEF) undergoing coronary artery bypass grafting (CABG). A total of 78 coronary artery disease (CAD) patients (54 males, 24 females) with symptoms and signs of heart failure and a left ventricular ejection fraction (LVEF)<40% were consecutively enrolled from January 2014 to December 2018 in Beijing Anzhen Hospital. The average age was (59±8) years old. Transthoracic echocardiography was performed to measure LVEF and left ventricle end-systolic volume index (LVESVI) during hospitalization, and the average LVESVI was (92±18) ml/m(2). According to the mean value of LVESVI, the patients were divided into 2 groups: mild left ventricle remodeling group (group M, 46, LVESVI<92 ml/m(2)) and severe left ventricle remodeling group (group S, 32, LVESVI≥92 ml/m(2)). The follow-up period was (30±12) months. Operative mortality, perioperative complications and long-term survival were compared between the two groups. Perioperative mortality was 5.1% (4/78), which was significantly higher in group S than that of group M (9.4% vs 2.2%, 0.03). The proportion of patients with intra-aortic balloon pump (IABP) was higher in group S than that of group M during the perioperative period (62.5% vs 36.9%, 0.01). Compared with patients in group M, those with severe left ventricle remodeling were more susceptible to atrial fibrillation after surgery (25.0% vs 6.5%, 0.02). The mean follow-up time was (30±12) months. There was no difference in major adverse cardiac event (MACE)-free survival in 12 month, 24 month and 36 month between the two groups (100% vs 100%, 87.9% vs 92.1%, 80.3% vs 78.3%, 0.68). Left ventricular remodeling increases the perioperative mortality and complications of patients with ischemic HFrEF undergoing CABG, but it has no impact on short-term survival.
探讨左心室重构对射血分数降低的心力衰竭（HFrEF）患者行冠状动脉旁路移植术（CABG）围手术期风险及短期生存的影响。2014年1月至2018年12月，在北京安贞医院连续纳入78例有心力衰竭症状和体征且左心室射血分数（LVEF）<40%的冠状动脉疾病（CAD）患者（男性54例，女性24例）。平均年龄为（59±8）岁。住院期间行经胸超声心动图检查测量LVEF和左心室收缩末期容积指数（LVESVI），平均LVESVI为（92±18）ml/m²。根据LVESVI均值将患者分为2组：轻度左心室重构组（M组，46例，LVESVI<92 ml/m²）和重度左心室重构组（S组，32例，LVESVI≥92 ml/m²）。随访时间为（30±12）个月。比较两组患者的手术死亡率、围手术期并发症及长期生存情况。围手术期死亡率为5.1%（4/78），S组显著高于M组（9.4%对2.2%，P=0.03）。围手术期S组主动脉内球囊反搏（IABP）使用比例高于M组（62.5%对36.9%，P=0.01）。与M组患者相比，重度左心室重构患者术后更易发生心房颤动（25.0%对6.5%，P=0.02）。平均随访时间为（30±12）个月。两组在12个月、24个月和36个月时无主要不良心脏事件（MACE）生存情况无差异（100%对100%，87.9%对92.1%，80.3%对78.3%，P=0.68）。左心室重构增加了缺血性HFrEF患者行CABG的围手术期死亡率和并发症，但对短期生存无影响。
