STRUCTURAL AND METABOLIC CORRELATES OF THE REVERSIBILITY OF CHRONIC LEFT-VENTRICULAR ISCHEMIC DYSFUNCTION IN HUMANS
STRUCTURAL AND METABOLIC CORRELATES OF THE REVERSIBILITY OF CHRONIC LEFT-VENTRICULAR ISCHEMIC DYSFUNCTION IN HUMANS
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DOI：
10.1152/ajpheart.1995.268.3.h1265
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发表时间：
1995-03-01
影响因子：
4.8
通讯作者：
WIJNS, W
中科院分区：
文献类型：
--
作者：
DEPRE, C;VANOVERSCHELDE, JLJ;WIJNS, W
用正电子发射断层扫描(PET)评估局部心肌灌注和葡萄糖摄取，确定血管重建后功能改善的功能不全的心肌。然而，心肌缺血损伤的超微结构模式在术后功能改善和不改善与残余血流和代谢的关系上知之甚少。因此，我们对24例冠状动脉疾病合并前壁功能不全的患者进行了动态正电子发射计算机断层扫描。手术中从功能不全的区域获得穿壁活检，并通过光学和电子显微镜分析纤维化和心肌细胞的存在。根据术后收缩功能的变化判断，16例患者的左心功能有改善。在血运重建后功能改善的心肌中，PET的术前血流量和葡萄糖摄取量高于持续功能不全的心肌。在术后改善的心肌组织样本中，有更多的心肌细胞，包括更大比例的糖原储存过剩的细胞(35%对21%)，与功能没有改善的心肌组织样本相比，纤维化较少(24%对49%)。术前血流灌注量和术后室壁运动与组织纤维化量呈负相关，而术前F-18标记的脱氧葡萄糖摄取量与心肌细胞糖原储备量呈正相关。
Assessment of regional myocardial perfusion and glucose uptake with positron emission tomography (PET) identifies dysfunctional myocardium that shows improvement in function after revascularization. Yet little is known about the ultrastructural patterns of ischemic injury in myocardium with and without postoperative functional improvement in relation to residual perfusion and metabolism. Therefore dynamic PET with [N-13]ammonia and F-18-labeled deoxyglucose was performed in 24 patients with coronary artery disease and anterior wall dysfunction undergoing bypass surgery. Transmural biopsies were obtained from the dysfunctional area during surgery and analyzed by optical and electron microscopy to quantify the presence of fibrosis and cardiomyocytes. As judged from the postoperative changes in contraction, left ventricular function improved in 16 patients. In myocardium that showed improved function after revascularization, preoperative flow and glucose uptake were higher by PET than in persistently dysfunctional myocardium. In tissue samples from myocardium that improved postoperatively, there were more cardiomyocytes, including a larger proportion of cells with excess glycogen stores (35 vs. 21%), and there was less fibrosis (24 vs. 49%) than in tissue samples from myocardium that did not improve functionally. Preoperative perfusion and postoperative wall motion were inversely correlated with the amount of tissue fibrosis, whereas preoperative F-18-labeled deoxyglucose uptake correlated positively with the amount of cardiomyocytes showing excess glycogen stores.