Patients with hibernating myocardium show altered left ventricular volumes and shape, which revert after revascularization - Evidence that dyssynergy might directly induce cardiac remodeling
Patients with hibernating myocardium show altered left ventricular volumes and shape, which revert after revascularization - Evidence that dyssynergy might directly induce cardiac remodeling
复制标题
DOI：
10.1016/j.jacc.2005.09.064
复制
发表时间：
2006-03-07
影响因子：
24
通讯作者：
Ambrosio, G
中科院分区：
文献类型：
--
作者：
Carlucclo, E;Biagioli, P;Ambrosio, G
目的探讨局部收缩功能障碍本身(即无跨壁坏死)是否可诱发缺血后左室重构，以及这种现象在收缩恢复后是否具有可逆性。背景广泛瘢痕组织的形成被认为是心肌梗死后左室重构的主要原因，但心肌坏死也会导致收缩功能丧失。方法通过二维超声心动图对42例慢性心功能不全患者在基础状态和冠状动脉血运重建后8+/-3个月时的整体和局部功能、体积和球性指数(SI)进行评估。用多巴酚丁胺超声心动图评价冠脉再通前的存活心肌。结果基础状态下，局部和整体功能降低，左室扩张。血管重建后，射血分数(从33+/-6%恢复到45+/-10%，P<0.0001)和室壁运动积分指数(从2.29±-0.31到1.74+/-0.42，P&t；0.0001)恢复。血管重建后，收缩末期容量指数(从78+/-23ml/m(2)至56+/-23ml/m(2)，P<；0.0001)、舒张期末容量指数(从118+/-26ml/m(2)至99+/-26ml/m(2)，P<；0.0001)和SI(从0.69+/-0.14p<；0.0001)也有显著改善。LV容量和SI的改善与血管重建术后恢复功能的节段数显著相关。结论冬眠心肌与LV体积和形状的主要变化有关，而LV体积和形状在血管重建后显著恢复。因此，慢性协同失调本身就足以诱导患者的缺血性左室重构。
OBJECTIVES The purpose of this study was to investigate whether post-ischemic left ventricular (LV) remodeling might be induced by regional contractile dysfunction per se (i.e., in the absence of transmural necrosis) and whether this phenomenon is potentially reversible after contractile recovery.BACKGROUND Formation of extensive scar tissue is thought to be chiefly responsible for post-infarction LV remodeling; however, myocardial necrosis also causes loss of contractility. We investigated LV geometry and shape in a setting in which contractile dysfunction occurs in the presence of preserved myocyte viability, and thus it is potentially reversible.METHODS In 42 patients with chronically dysfunctional myocardium, we evaluated (by two-dimensional echocardiography) LV global and regional function, volumes, and sphericity index (SI), at baseline and 8 +/- 3 months after coronary revascularization. Myocardial viability before rcvascularization was evaluated by dobutamine echocardiography.RESULTS At baseline, regional and global function were depressed and LV dilation was present. Revascularization was followed by recovery of ejection fraction (from 33 +/- 6% to 45 +/- 10%, p < 0.0001) and wall motion score index (from 2.29 +/- 0.31 to 1.74 +/- 0.42, p < 0.0001). After revascularization, significant improvement of end-systolic volume index (from 78 +/- 23 ml/m(2) to 56 +/- 23 ml/m(2), p < 0.0001), end-diastolic volume index (from 118 +/- 26 ml/m(2) to 99 +/- 26 ml/m(2), P < 0.0001), and SI (from 0.69 +/- 0.14 to 0.52 +/- 0.11, p < 0.0001) was also observed. Improvement in LV volumes and SI were significantly correlated to the number of segments recovering function after revascularization.CONCLUSIONS Hibernating myocardium is associated with major alterations in LV volumes and shape, which significantly revert after revascularization. Thus, chronic dyssynergy per se is sufficient to induce ischemic LV remodeling in patients.