Correlation of functional recovery with myocardial blood flow, glucose uptake, and morphologic features in patients with chronic left ventricular ischemic dysfunction undergoing coronary artery bypass grafting
Correlation of functional recovery with myocardial blood flow, glucose uptake, and morphologic features in patients with chronic left ventricular ischemic dysfunction undergoing coronary artery bypass grafting
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DOI：
10.1016/s0022-5223(97)70335-0
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发表时间：
1997-02-01
影响因子：
6
通讯作者：
Dion, R
中科院分区：
文献类型：
--
作者：
Depre, C;Vanoverschelde, JLJ;Dion, R
目的：探讨术前心肌超微结构和代谢对冠心病合并左心功能不全患者冠状动脉旁路移植术后收缩功能恢复的影响，方法：采用N-13氨和IgF-脱氧葡萄糖动态正电子发射断层扫描技术评估53例因冠心病合并左心功能不全而拟行冠状动脉血运重建的患者的心肌灌注和葡萄糖摄取情况，了解组织纤维化的程度以及是否存在潜在的纤维化。从透壁活检标本中量化心肌细胞的可逆性改变（肌丝损失和糖原积累），这些标本是在手术期间从功能障碍区域的中心采集并用光学显微镜进行分析，根据术前和术后 6 个月通过心室造影或超声心动图检查左心室功能的变化来评估收缩性能的恢复，结果：根据术后局部室壁运动的变化，认为左心室功能在 34 个月内有所改善室壁运动改善的患者中，射血分数上升 12%，收缩末期容积减少 28%；相比之下，持续功能障碍的患者中，射血分数下降 6%，收缩末期容积增加 25%。在血运重建之前，具有可逆性功能障碍的心肌表现出比心肌血流量更高的绝对心肌血流量、更高的心肌葡萄糖摄取、更少的组织纤维化和更多改变的心肌细胞。结论：在左心室缺血性功能障碍患者中，手术血运重建后局部和整体左心室功能的恢复与术前较高的血流量和葡萄糖摄取、功能障碍区域组织纤维化较少和较高数量的存活心肌细胞相关，本研究由此证实无创术前代谢成像对于识别残余存活心肌和预测血运重建后功能结果的价值。
Objective: Our objective was to investigate the influence of preoperative myocardial ultrastructure and metabolism on recovery of contractile function after coronary artery bypass grafting in patients with coronary artery disease and left ventricular dysfunction, Methods: Dynamic positron emission tomography with N-13-ammonia and IgF-deoxyglucose was used to assess myocardial perfusion and glucose uptake in 53 patients scheduled for coronary revascularization because of coronary artery disease and left ventricular dysfunction, The degree of tissue fibrosis and the presence of potentially reversible alterations of cardiomyocytes (loss of myofilaments and accumulation of glycogen) were quantified from transmural biopsy specimens, These were harvested from the center of the dysfunctional area during the operation and analyzed with a light microscope, The recovery of contractile performance was assessed from the changes in left ventricular function at contrast ventriculography or echocardiography before and 6 months after the operation, Results: According to postoperative changes in regional wall motion, left ventricular function was considered to have improved in 34 patients, whereas dysfunction persisted in 19 patients, In patients with improved wall motion, ejection fraction rose by 12% and end-systolic volume decreased by 28%, By contrast, in patients with persistent dysfunction, ejection fraction decreased by 6% and end-systolic volume increased by 25%, Before revascularization, myocardium with reversible dysfunction displayed higher levels of absolute myocardial blood flow, higher myocardial glucose uptake, less tissue fibrosis, and more altered cardiomyocytes than myocardium with persistent dysfunction, Significant correlations were found between regional blood flow and the surface of the biopsy specimen covered by fibrosis, as well as between glucose uptake and the density of altered cardiomyocytes, Conclusion: In patients with left ventricular ischemic dysfunction, the recovery of regional and global left ventricular function after surgical revascularization is associated with higher preoperative blood how and glucose uptake, with less tissue fibrosis and a higher amount of viable cardiomyocytes in the dysfunctional area, The current study thus confirms the value of noninvasive preoperative metabolic imaging for identification of residual viable myocardium and for prediction of the functional outcome after revascularization.