Vanoverschelde J L, Gerber B L, D'Hondt A M, De Kock M, Dion R, Wijns W, Melin J A
Division of Cardiology, University of Louvain Medical School, Brussels, Belgium.
Circulation. 1995 Nov 1;92(9 Suppl):II37-44. doi: 10.1161/01.cir.92.9.37.
Both thallium imaging and low-dose dobutamine echocardiography have been proposed to predict the reversibility of left ventricular (LV) dysfunction in patients with coronary disease. The present study was designed to evaluate whether the use of these techniques during the preoperative assessment of coronary patients with depressed LV function can improve our ability to identify those likely to have improved LV function after surgery.
Forty consecutive patients (age, 60 +/- 10 years) with coronary disease and an ejection fraction < or = 35% underwent dobutamine echocardiography (10 micrograms/kg per minute) and exercise-redistribution-reinjection thallium single photon emission computed tomography (SPECT) before coronary revascularization by bypass surgery (n = 33) or angioplasty (n = 7). Recovery of LV function was evaluated by echocardiography 5.3 +/- 2.4 months after revascularization. According to the changes in end-systolic volume and ejection fraction after revascularization, the patients were categorized into groups with (n = 19) and without (n = 21) postoperative functional improvement, defined as a > 5% increase in ejection fraction and > 10 mL decrease in end-systolic volume. Before revascularization, patients with improved postoperative function had smaller end-diastolic volume and less wall motion abnormalities than those with persistent dysfunction. They also showed greater improvement of wall motion score with dobutamine (6.1 +/- 2.4 versus 1.8 +/- 4.2 grades, P < .001) and smaller thallium defect score after exercise (38 +/- 12 versus 47 +/- 14 grades, P = .04). Discriminant analysis selected the improvement in wall motion score with dobutamine and baseline end-diastolic volume as independent predictors of postoperative recovery. Consideration of both parameters allowed prediction of functional outcome in 84% of the patients with and 81% of those without postoperative improvement.
Among the parameters commonly available before surgery in coronary patients with depressed LV function, the maintenance of significant inotropic reserve, the severity of LV remodeling, and the magnitude of the perfusion defect after exercise can predict the reversal of LV dysfunction after revascularization.
铊显像和低剂量多巴酚丁胺超声心动图均已被用于预测冠心病患者左心室（LV）功能障碍的可逆性。本研究旨在评估在左心室功能低下的冠心病患者术前评估中使用这些技术是否能提高我们识别术后左心室功能可能改善患者的能力。
40例连续的冠心病患者（年龄60±10岁），射血分数≤35%，在接受冠状动脉搭桥手术（n = 33）或血管成形术（n = 7）进行血运重建之前，接受了多巴酚丁胺超声心动图检查（每分钟10微克/千克）和运动-再分布-再注射铊单光子发射计算机断层扫描（SPECT）。在血运重建后5.3±2.4个月通过超声心动图评估左心室功能的恢复情况。根据血运重建后收缩末期容积和射血分数的变化，将患者分为术后功能改善组（n = 19）和未改善组（n = 21），术后功能改善定义为射血分数增加>5%且收缩末期容积减少>10 mL。在血运重建前，术后功能改善的患者与持续功能障碍的患者相比，舒张末期容积更小，壁运动异常更少。他们在多巴酚丁胺作用下壁运动评分的改善也更大（6.1±2.4级对1.8±4.2级，P <.001），运动后铊缺损评分更小（38±12级对47±14级，P =.04）。判别分析选择多巴酚丁胺作用下壁运动评分的改善和基线舒张末期容积作为术后恢复的独立预测因子。综合考虑这两个参数，可对84%的术后功能改善患者和81%的术后未改善患者的功能结局进行预测。
在左心室功能低下的冠心病患者术前常用的参数中，显著的变力性储备的维持、左心室重构的严重程度以及运动后灌注缺损的大小可预测血运重建后左心室功能障碍的逆转。
