Myocardial scar identified by magnetic resonance imaging can predict left ventricular functional improvement after coronary artery bypass grafting.
Myocardial scar identified by magnetic resonance imaging can predict left ventricular functional improvement after coronary artery bypass grafting.
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磁共振成像识别的心肌疤痕可以预测冠状动脉搭桥术后左心室功能的改善
DOI：
10.1371/journal.pone.0081991
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Zhao SH
中科院分区：
文献类型：
--
作者：
Yang T;Lu MJ;Sun HS;Tang Y;Pan SW;Zhao SH
背景先前的研究表明，存活心肌预示着血运重建后左心功能不全的恢复。我们的目的是评价晚期Gd增强心血管磁共振成像(LGE-CMR)评估心肌瘢痕对冠状动脉旁路移植术(CABG)患者功能恢复的预后价值。方法对2009年11月至2012年9月63例首次单纯性冠状动脉搭桥术中左室射血分数(LVEF)降低的患者进行前瞻性研究，52例进入最终分析。分别于术前和术后6个月应用LGE-CMR评价左心功能参数和瘢痕组织。冠状动脉搭桥术后6个月行CT血管造影(CTA)评估移植物的通畅性。对影响整体功能恢复的预测因素进行分析。结果基础左心室射血分数为(32.7±9.2)%，6个月后改善为(41.6±11.0)%，32/5 2例患者左心室射血分数(≥)提高5%。多因素Logistic回归分析显示，影响整体功能恢复的最显著的负向预测因素是瘢痕节段的数量(优势比2.864，95%可信区间1.172-6.996，p = 0.021)。受试者-操作者特征分析显示，≤-4-SCAR节段预测整体功能恢复的敏感性和特异性分别为85.0%和87.5%(AUC = 0.91，p<；0.001)。ROC曲线的比较也表明，瘢痕组织在预测心功能恢复方面优于存活心肌(p<；0.001)。结论LGE-CMR上的瘢痕组织是冠状动脉旁路移植术中左心功能受损患者心功能恢复的一个独立的负向预测因子。这些观察结果可能有助于临床医生和心血管外科医生确定哪些患者最有可能从外科血管重建术中受益。
Background Previous studies have shown that viable myocardium predicts recovery of left ventricular (LV) dysfunction after revascularization. Our aim was to evaluate the prognostic value of myocardial scar assessed by late gadolinium-enhanced cardiovascular magnetic resonance imaging (LGE-CMR) on functional recovery in patients undergoing coronary artery bypass grafting (CABG). Methods From November 2009 to September 2012, 63 patients with reduced left ventricular ejection fraction (LVEF) referred for first-time isolated CABG were prospectively enrolled, 52 were included in final analysis. LV functional parameters and scar tissue were assessed by LGE-CMR at baseline and 6 months after surgery. Patency of grafts was evaluated by computed tomography angiography (CTA) 6 months post-CABG. Predictors for global functional recovery were analyzed. Results The baseline LVEF was 32.7±9.2%, which improved to 41.6±11.0% 6 months later and 32/52 patients improved LVEF by ≥5%. Multivariate logistic regression analysis showed that the most significant negative predictor for global functional recovery was the number of scar segments (Odds ratio 2.864, 95% Confidence Interval 1.172–6.996, p = 0.021). Receiver-Operator-Characteristic (ROC) analysis demonstrated that ≤4 scar segments predicted global functional recovery with a sensitivity and specificity of 85.0% and 87.5%, respectively (AUC = 0.91, p<0.001). Comparison of ROC curves also indicated that scar tissue was superior to viable myocardium in predicting cardiac functional recovery (p<0.001). Conclusions Our findings indicated that scar tissue on LGE-CMR is an independent negative predictor of cardiac functional recovery in patients with impaired LV function undergoing CABG. These observations may be helpful for clinicians and cardiovascular surgeons to determine which patients are most likely to benefit from surgical revascularization.
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