心肌存活性和左心室重构对冠状动脉旁路移植术后射血分数降低的心力衰竭患者生存的影响。
Effects of myocardial viability and left ventricular remodeling on survival of patients with heart failure and reduced ejection fraction after coronary artery bypass grafting.
作者信息
Cao Jian, Dong Ran, Zhang Kui, Zhang Hongjia
机构信息
Department of Cardiac Surgery, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Beijing Lab for Cardiovascular Precision Medicine, Beijing 100029, China.
出版信息
Cardiovasc Diagn Ther. 2020 Apr;10(2):183-192. doi: 10.21037/cdt.2020.01.11.
BACKGROUND
Heart failure with reduced ejection fraction (HFrEF) caused by coronary heart disease (CHD) accounts for the largest proportion of patients with heart failure and is associated with the poorest prognosis. However, date on the perioperative risk and long-term survival of patients with HFrEF are limited. The present study aimed at exploring the effects of the left ventricular end-systolic volume index (LVESVI) and myocardial viability on perioperative risk and long-term survival after coronary artery bypass grafting (CABG) in patients with HFrEF.
METHODS
This is a single center, prospective, observational study. CHD patients with symptoms and signs of heart failure and a left ventricular ejection fraction (LVEF) <40% were enrolled consecutively from January 2014 to February 2018. Operative mortality, perioperative complications and long-term survival were compared in the patients with various LVESVIs and myocardial viabilities. The primary outcomes were cardiac death, myocardial infarction, heart failure, stroke and revascularization [percutaneous coronary intervention (PCI) or redo CABG] with a median follow-up of 30±12 months.
RESULTS
Perioperative mortality was 6.8% in the 118 patients in this study. Perioperative mortality was significantly higher in the low myocardial viability (LMV) group than in the high myocardial viability (HMV) group (12.5% . 3.8%, P=0.034). The 12-, 24-, 36-month major adverse cardiac event (MACE)-free survival rate of patients with HMV was significantly higher than that of patients with LMV (HMV . LMV: 96.9% . 88.6%, 93.4% . 85.5%, 79.4% . 68.2%, P=0.004). There was no difference in MACE-free survival among patients with different degrees of left ventricular remodeling within each group.
CONCLUSIONS
Myocardial viability is an important factor that affects the perioperative mortality and long-term survival of patients with ischemic HFrEF after CABG. Left ventricular remodeling increases perioperative mortality but has no effect on long-term survival.
背景
冠心病（CHD）所致射血分数降低的心力衰竭（HFrEF）在心力衰竭患者中占比最大，且预后最差。然而，关于HFrEF患者围手术期风险和长期生存的数据有限。本研究旨在探讨左心室收缩末期容积指数（LVESVI）和心肌存活能力对HFrEF患者冠状动脉旁路移植术（CABG）后围手术期风险和长期生存的影响。
方法
这是一项单中心、前瞻性观察性研究。2014年1月至2018年2月连续纳入有心力衰竭症状和体征且左心室射血分数（LVEF）<40%的CHD患者。比较不同LVESVI和心肌存活能力患者的手术死亡率、围手术期并发症和长期生存情况。主要结局为心脏死亡、心肌梗死、心力衰竭、中风和血运重建[经皮冠状动脉介入治疗（PCI）或再次CABG]，中位随访时间为30±12个月。
结果
本研究的118例患者围手术期死亡率为6.8%。低心肌存活能力（LMV）组围手术期死亡率显著高于高心肌存活能力（HMV）组（12.5%对3.8%，P = 0.034）。HMV患者12个月、24个月、36个月无主要不良心脏事件（MACE）生存率显著高于LMV患者（HMV对LMV：96.9%对88,6%，93.4%对85.5%，79.4%对68.2%，P = 0.004）。每组内不同程度左心室重构患者的无MACE生存率无差异。
结论
心肌存活能力是影响缺血性HFrEF患者CABG后围手术期死亡率和长期生存的重要因素。左心室重构增加围手术期死亡率，但对长期生存无影响。
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