缺血性心肌病患者接受外科治疗后左心室功能恢复的发生率、决定因素和临床影响。
Incidence, determinants and clinical impact of left ventricular function recovery after surgical treatments for ischaemic cardiomyopathy.
机构信息
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Division of Biomedical Statistics, Department of Integrated Medicine, Graduate School of Medicine, Osaka University, Suita, Japan.
出版信息
Eur J Cardiothorac Surg. 2021 Sep 11;60(3):689-696. doi: 10.1093/ejcts/ezab122.
OBJECTIVES
This retrospective study aimed to clarify the incidence, determinants and clinical impact of left ventricular (LV) function non-recovery after coronary artery bypass grafting (CABG) in patients with ischaemic cardiomyopathy.
METHODS
A total of 490 patients with ischaemic cardiomyopathy (LV ejection fraction ≤ 40%) undergoing CABG were analysed. Follow-up echocardiography was performed at 1 month, 1 year, and annually thereafter. LV function recovery was defined as ejection fraction (EF) ≥40% at least once during follow-up. LV function non-recovery was defined as EF <40% at any follow-up. The primary and secondary end points were changes in LV function and all-cause mortality, respectively. Clinical follow-up was completed in 461 patients (94.1%; mean follow-up: 64.5 ± 45.5 months).
RESULTS
During follow-up, echocardiographic assessments were performed 1863 times (mean, 3.8 ± 2.4), and 193 patients (39.4%) exhibiting LV function non-recovery were identified. Overall survival was significantly higher in the recovery group (53.9%) than in the non-recovery group (31.4%) at 10 years (P < 0.001). Independent predictors of LV function non-recovery were preoperative LV end-systolic diameter [odds ratio (OR) 1.07, 95% confidence interval (CI) 1.04-1.10; P < 0.001] and bilateral internal thoracic artery grafting (OR 0.61, 95% CI 0.39-0.95; P = 0.028). In a multivariable Cox proportional hazards model, LV function non-recovery was significantly associated with all-cause mortality (hazard ratio 2.14, 95% CI 1.60-2.86; P < 0.001).
CONCLUSIONS
Almost 40% of patients with ischaemic cardiomyopathy undergoing CABG did not achieve LV function recovery and were associated with poor prognosis. To achieve LV function recovery, CABG with bilateral internal thoracic artery may be recommended before excessive LV remodelling occurs.
CLINICAL TRIAL REGISTRATION NUMBER
Institutional review board of Osaka University Hospital, number 16105.
目的
本回顾性研究旨在阐明缺血性心肌病患者冠状动脉旁路移植术后（CABG）左心室（LV）功能无法恢复的发生率、决定因素和临床影响。
方法
分析了 490 例缺血性心肌病（LV 射血分数≤40%）患者的资料，所有患者均接受了 CABG 治疗。术后 1 个月、1 年以及此后每年进行随访超声心动图检查。LV 功能恢复定义为至少一次随访时射血分数（EF）≥40%。LV 功能未恢复定义为任何随访时 EF<40%。主要终点和次要终点分别为 LV 功能变化和全因死亡率。461 例患者（94.1%；平均随访：64.5±45.5 个月）完成了临床随访。
结果
随访期间共进行了 1863 次超声心动图评估（平均 3.8±2.4 次），193 例（39.4%）患者出现 LV 功能未恢复。10 年时，恢复组（53.9%）的总体生存率明显高于未恢复组（31.4%）（P<0.001）。LV 功能未恢复的独立预测因素为术前 LV 收缩末期直径[比值比（OR）1.07，95%置信区间（CI）1.04-1.10；P<0.001]和双侧胸廓内动脉旁路移植（OR 0.61，95%CI 0.39-0.95；P=0.028）。多变量 Cox 比例风险模型显示，LV 功能未恢复与全因死亡率显著相关（风险比 2.14，95%CI 1.60-2.86；P<0.001）。
结论
近 40%接受 CABG 的缺血性心肌病患者未实现 LV 功能恢复，且预后不良。为了实现 LV 功能恢复，在 LV 重构过度发生之前，可能建议使用双侧胸廓内动脉进行 CABG。
临床试验注册号
大阪大学医院机构审查委员会，编号 16105。
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