Kozman H, Cook J R, Wiseman A H, Dann R H, Engelman R M
Department of Cardiology, Baystate Medical Center, Springfield, MA 01199, USA.
Circulation. 1998 Nov 10;98(19 Suppl):II57-61.
Patients with coronary artery disease and left ventricular dysfunction (LVD) may have areas of hibernating myocardium that improve functionally after revascularization. Coronary collateral circulation may sustain ischemic, dysfunctional myocardium and favor myocardial recovery after revascularization. We evaluated the effect of angiographic coronary collaterals on myocardial functional recovery after coronary bypass graft (CABG) surgery in a group of patients with severe LVD.
Forty-one patients with multivessel coronary artery disease and advanced LVD (left ventricular ejection fraction [LVEF] 25 +/- 5%) undergoing CABG were identified from a prospective database. Preoperative coronary angiograms were evaluated for collaterals, which were graded according to Rentrop's classification (0 to 3), and a collateral index was calculated (collateral sum divided by 3). Preoperative and postoperative radionuclide ventriculograms provided global LVEF and regional ejection fractions. Of 123 regions evaluated, 120 were dysfunctional at baseline. Virtually all (122 of 123) regions were subtended by an artery with > or = 70% stenosis that was bypassed. Thirty-eight (81%) of 47 dysfunctional regions with grade 2 or 3 collaterals improved regional ejection fraction after surgery versus 38 (52%) of 73 dysfunctional regions with grade 0 or 1 collaterals (P = 0.0018). Global LVEF was 34 +/- 10% after surgery (P < 0.001 versus before surgery). Among patients with a global LVEF increase > or = 10%, collateral index was 1.81 versus 0.83 in those with an LVEF increase < 10% (P = 0.005).
In this population of patients with coronary artery disease with severe LVD, the presence of angiographic grade 2 or 3 collaterals predicted recovery of regional and global myocardial function after CABG.
患有冠状动脉疾病和左心室功能障碍（LVD）的患者可能存在冬眠心肌区域，血管重建术后其功能会得到改善。冠状动脉侧支循环可维持缺血性功能失调心肌，并有利于血管重建术后心肌恢复。我们评估了血管造影显示的冠状动脉侧支对一组严重左心室功能障碍患者冠状动脉搭桥术（CABG）后心肌功能恢复的影响。
从一个前瞻性数据库中识别出41例患有多支冠状动脉疾病和晚期左心室功能障碍（左心室射血分数[LVEF]为25±5%）且接受冠状动脉搭桥术的患者。术前冠状动脉造影评估侧支情况，根据Rentrop分类法（0至3级）对侧支进行分级，并计算侧支指数（侧支总和除以3）。术前和术后放射性核素心室造影提供整体左心室射血分数和局部射血分数。在评估的123个区域中，120个区域在基线时功能失调。几乎所有（123个中的122个）区域都由一条狭窄程度≥70%且已被搭桥的动脉供血。47个功能失调区域中，有38个（81%）具有2级或3级侧支的区域术后局部射血分数得到改善，而73个功能失调区域中，有38个（52%）具有0级或1级侧支的区域术后局部射血分数得到改善（P = 0.0018）。术后整体左心室射血分数为34±10%（与术前相比，P < 0.001）。在整体左心室射血分数增加≥10%的患者中，侧支指数为1.81，而在左心室射血分数增加<10%的患者中，侧支指数为0.83（P = 0.005）。
在这群患有严重左心室功能障碍的冠状动脉疾病患者中，血管造影显示的2级或3级侧支的存在预示着冠状动脉搭桥术后局部和整体心肌功能的恢复。
