Frazier O H, Cooley D A, Kadipasaoglu K A, Pehlivanoglu S, Lindenmeir M, Barasch E, Conger J L, Wilansky S, Moore W H
Cullen Cardiovascular Research Laboratories, Texas Heart Institute, Houston 77225-0345, USA.
Circulation. 1995 Nov 1;92(9 Suppl):II58-65. doi: 10.1161/01.cir.92.9.58.
We assessed the transmyocardial laser revascularization (TMLR) as sole therapy in patients with symptomatic coronary artery disease refractory to interventional or medical treatment.
Thirty-one patients were evaluated with positron emission tomography (PET), dobutamine echocardiography, 201Tl single-photon emission computed tomography (201Tl-SPECT), and multigated acquisition radionuclide ventriculography (MUGA). TMLR was performed in 21 patients who had demonstrable ischemia in viable myocardium. The mean Canadian Cardiovascular Society (CCS) angina class was 3.70 +/- 0.7 (4 patients with unstable angina). Untreated septal segments were used as controls. At 3 months, (n = 15 patients), the mean CCS angina class was to 2.43 +/- 0.9 (P < .05). On dobutamine echocardiography, the mean resting wall motion score index was improved by 16% in lased segments (P < .03 vs control), and mean LVEF at peak stress increased by 19% (P = NS vs baseline). On 201Tl-SPECT, perfusion of lased and nonlased segments did not change. On PET, the mean ratio of subendocardial to subepicardial perfusion (SEn/SEp) increased 14% over baseline (P < .001 vs control). At 6 months (n = 15 patients), the mean CCS angina class was 1.7 +/- 0.8 (P < .05). The mean resting wall motion score index was up by 13% in lased segments (P < .05 vs control). Resting LVEF was unchanged. Stress LVEF increased 21% (P = NS vs baseline). Myocardial perfusion remained unchanged by 201Tl-SPECT. On PET, 36% of the lased segments were better, and 25% were worse compared with baseline. The resting SEn/SEp by PET was up 21% (P < .001 vs control). All deaths (two perioperative and three late) occurred in patients with preoperative congestive heart failure. Two patients required repeat revascularization of new coronary lesions.
These results suggest that TMLR improves anginal status, relative endocardial perfusion, and cardiac function in patients who do not have preoperative congestive heart failure.
我们评估了经心肌激光血运重建术（TMLR）作为对介入治疗或药物治疗无效的有症状冠状动脉疾病患者的唯一治疗方法。
对31例患者进行了正电子发射断层扫描（PET）、多巴酚丁胺超声心动图、201铊单光子发射计算机断层扫描（201Tl-SPECT）和多门控采集放射性核素心室造影（MUGA）检查。对21例存活心肌有明显缺血的患者实施了TMLR。加拿大心血管学会（CCS）心绞痛分级平均为3.70±0.7（4例不稳定型心绞痛患者）。未治疗的室间隔节段用作对照。3个月时（n = 15例患者），CCS心绞痛分级平均降至2.43±0.9（P < 0.05）。在多巴酚丁胺超声心动图检查中，激光治疗节段的平均静息壁运动评分指数改善了16%（与对照相比，P < 0.03），峰值负荷时的平均左心室射血分数（LVEF）增加了19%（与基线相比，P = 无显著差异）。在201Tl-SPECT检查中，激光治疗节段和未激光治疗节段的灌注情况未发生变化。在PET检查中，心内膜下与心外膜下灌注的平均比值（SEn/SEp）较基线水平增加了14%（与对照相比，P < 0.001）。6个月时（n = 15例患者），CCS心绞痛分级平均为1.7±0.8（P < 0.05）。激光治疗节段的平均静息壁运动评分指数上升了13%（与对照相比，P < 0.05）。静息LVEF未改变。负荷LVEF增加了21%（与基线相比，P = 无显著差异）。201Tl-SPECT检查显示心肌灌注未发生变化。在PET检查中，与基线相比，36%的激光治疗节段情况改善，25%的节段情况变差。PET检查的静息SEn/SEp上升了21%（与对照相比，P < 0.001）。所有死亡病例（2例围手术期死亡和3例晚期死亡）均发生在术前有充血性心力衰竭的患者中。2例患者需要对新的冠状动脉病变进行再次血运重建。
这些结果表明，TMLR可改善无术前充血性心力衰竭患者的心绞痛状况、相对心内膜灌注和心脏功能。
