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冠状动脉旁路移植术后早期心脏多排 CT 的临床应用。

Clinical utility of early postoperative cardiac multidetector computed tomography after coronary artery bypass grafting.

机构信息

Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea.

Department of Thoracic & Cardiovascular Surgery, Ajou University School of Medicine, Suwon, Republic of Korea.

出版信息

Sci Rep. 2020 Jun 8;10(1):9186. doi: 10.1038/s41598-020-66176-6.

Abstract

We evaluated the clinical utility of early postoperative cardiac computed tomography (CT) for evaluating left ventricular (LV) function and predicting prognosis in patients who had undergone coronary artery bypass grafting (CABG). Of the 205 patients who underwent CABG from March 2011 to December 2014, 136 underwent early postoperative cardiac CT (within 30 days after CABG) and were enrolled as the study population. The baseline and postoperative follow-up echocardiographic findings, major adverse cardiac events (MACE), and death were recorded for a follow-up period (mean, 5.9 ± 1.1 years). Functional cardiac CT parameters were compared to echocardiographic measurements. The associations between cardiac CT findings and functional recovery and prognosis were evaluated by logistic regression analyses. The LVEF measured via cardiac CT was significantly higher (56.2 ± 11.5% vs. 61.9 ± 12.9%; p = 0.0002) compared to those via early postoperative echocardiography, but the wall motion score index (WMSI) was not significantly different (1.23 ± 0.33 vs. 1.21 ± 0.28, p = 0.5041) between the two methods. During the follow-up period, 17 patients (12.5%) died and 40 (29.4%) developed MACE. Both the LVEF and WMSI measured with early postoperative echocardiography (p = 0.0202 and odds ratio [OR] = 5.0171, p = 0.0039, respectively), and cardiac CT (OR = 0.9625, p = 0.0091 and OR = 14.3605, p = 0.0001, respectively) predicted MACE OR = 0.9630, but only the WMSI, measured using cardiac CT, predicted all-cause death (OR = 10.6017, p = 0.0035). In CABG patients, LVEF and the WMSI measured with early postoperative cardiac CT were comparable with echocardiography and predicted the development of MACE and all-cause death.

摘要

我们评估了冠状动脉旁路移植术(CABG)后早期心脏 CT(在 CABG 后 30 天内)对评估左心室(LV)功能和预测预后的临床价值。在 2011 年 3 月至 2014 年 12 月期间接受 CABG 的 205 例患者中,有 136 例接受了早期术后心脏 CT 检查,并被纳入研究人群。记录基线和术后随访的超声心动图结果、主要不良心脏事件(MACE)和死亡情况,随访时间(平均 5.9±1.1 年)。比较了心脏 CT 功能参数与超声心动图测量结果。通过逻辑回归分析评估心脏 CT 检查结果与功能恢复和预后的相关性。通过心脏 CT 测量的 LVEF 显著高于术后早期超声心动图(56.2±11.5% vs. 61.9±12.9%;p=0.0002),但壁运动评分指数(WMSI)两种方法之间无显著差异(1.23±0.33 vs. 1.21±0.28,p=0.5041)。在随访期间,17 例患者(12.5%)死亡,40 例患者(29.4%)发生 MACE。术后早期超声心动图测量的 LVEF 和 WMSI(p=0.0202 和优势比[OR] = 5.0171,p=0.0039),以及心脏 CT(OR = 0.9625,p=0.0091 和 OR = 14.3605,p=0.0001)均预测了 MACE(OR = 0.9630),但只有 WMSI(使用心脏 CT 测量)预测了全因死亡(OR = 10.6017,p=0.0035)。在 CABG 患者中,术后早期心脏 CT 测量的 LVEF 和 WMSI 与超声心动图相似,可预测 MACE 和全因死亡的发生。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7026/7280270/257e41d91a77/41598_2020_66176_Fig1_HTML.jpg

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