Reverse remodeling and improved regional function after repair of left ventricular aneurysm
Reverse remodeling and improved regional function after repair of left ventricular aneurysm
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DOI：
10.1067/mtc.2002.120710
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发表时间：
2002-04-01
影响因子：
6
通讯作者：
Savage, EB
中科院分区：
文献类型：
--
作者：
Kramer, CM;Magovern, JA;Savage, EB
背景资料：通过磁共振标记，可以无创地研究人类受试者前尖部动脉瘤修复后左心室局部力学的变化。我们假设修复后左心室心肌内功能会改善整个左心室。我们研究了6例男性左心室前尖部动脉瘤患者（平均年龄+/- SD，63 +/- 5岁）在动脉瘤修复术、冠状动脉旁路移植术前3 +/- 1周和术后6 +/- 1周使用磁共振标记，二尖瓣修复术2例。屏气标记成像在短轴上从心尖到基底横跨左心室。测量左心室质量、舒张末期和收缩末期容积以及射血分数。应用二维应变分析;对左心室心尖部、中部和基底部以及整个左心室取平均值;并表示为最大延长（类似于壁增厚）、最大缩短和延长应变与径向的角度偏差。动脉瘤修复后，左心室质量从373 ± 27 g降至333 ± 25 g（P < .05），舒张末期容积从212 +/- 22至168 +/- 18 mL收缩末期容积从188 +/- 26 mL提高到113 +/- 18 mL（P < .005）;射血分数从13% +/- 4%提高到23% +/- 4%（P < .005）。对于整个左心室，延长应变从术前增加到术后（8% +/- 1%到10% +/-1%，P <0.01）。大部分改善的延长发生在左心室中部（8% +/- 1%至11% +/-1%，P < .01），底部（8% +/- 1%至10% +/-1%，P < .05）和下壁（9% +/- 1%至12% +/-1%，P < .05）。延长倾向于变得更加径向取向，从31 3度下降到27 +/-3度（P = 0.10）。缩短应变没有改变（10% +/- 1%至11% +/-1%，P =不显著）。结论：左室室壁瘤修复术与逆向重构和心肌内功能的范围和方向的改善有关，特别是在左室中部和基底部以及下壁。
Background: Changes in regional left ventricular mechanics after anteroapical aneurysm repair in human subjects can be studied noninvasively by means of magnetic resonance tagging. We hypothesized that left ventricular intramyocardial function would improve throughout the left ventricle after repair.Methods: We studied 6 male patients with a left ventricular anteroapical aneurysm (mean age +/- SD, 63 +/- 5 years) using magnetic resonance tagging 3 +/- 1 weeks before and 6 +/- 1 weeks after aneurysm repair, coronary artery bypass grafting, and mitral valve repair (n = 2). Breath-hold tagged imaging spanned the left ventricle in the short axis from apex to base. Left ventricular mass, end-diastolic and end-systolic volume, and ejection fraction were measured. Two-dimensional strain analysis was applied; averaged for the apical, middle, and basal left ventricle and the whole left ventricle; and expressed as greatest lengthening (similar to wall thickening), greatest shortening, and angular deviation of the lengthening strain from the radial direction.Results: After aneurysm repair, left ventricular mass decreased from 373 27 to 333 +/- 25 g (P < .05), end-diastolic volume from 212 +/- 22 to 168 +/- 18 mL (P < .005), and end-systolic volume from 188 +/- 26 to 113 +/- 18 mL (P < .005); ejection fraction improved from 13% +/- 4% to 23% +/- 4% (P < .005). For the whole left ventricle, lengthening strain increased from before to after the operation (8% +/- 1% to 10% +/- 1%, P < .01). Most of the improved lengthening occurred at the middle left ventricle (8% +/- 1% to 11% +/- 1%, P < .01), in the base (8% +/- 1% to 10% +/- 1%, P < .05), and in the inferior wall (9% +/- 1% to 12% +/- 1%, P < .05). Lengthening tended to become more radially oriented, decreasing from 31 3 to 27degrees +/- 3degrees (P = .10). Shortening strain did not change (10% +/- 1% to 11% +/- 1%, P = not significant).Conclusions: Left ventricular aneurysm repair is associated with reverse remodeling and an improvement in the extent and orientation of intramyocardial function, especially at the middle and basal left ventricle and inferior wall.