Impact of surgical revascularization strategy on left ventricular function, myocardial perfusion and clinical outcomes

项目摘要 冠状动脉疾病(CAD)是导致发病率和死亡率的主要原因：经冠状动脉血管重建术 动脉旁路移植术(CABG)是冠心病的一种常见治疗方法，可通过两种方法中的任一种进行 (SAG)或多动脉移植(MAG)策略。而动脉移植物的长期通畅性要好于 在静脉移植方面，数据表明接受MAG的患者围手术期风险更高。心脏 已知功能可以预测冠状动脉搭桥术后的预后，但不同的血运重建方法对预后的影响 心功能及其对临床结果的影响尚不完全清楚。在这件事上- 提交K23提案，我将以我在心胸麻醉和先进的ECHO方面的背景为基础 两种不同血运重建策略(SAG与MAG)对心脏的影响 在冠状动脉搭桥术后立即发挥作用和随后的临床结果，以提供一个框架 冠状动脉旁路移植术患者的围手术期处理。在目标1中，我将研究冠状动脉旁路移植术血运重建的影响。 由回声应变定义的心功能变化的策略。我将确定MAG是否会导致较低 通过经食道超声心动图测量从基线到手术后的心功能。我 还将评估变化的ECHO菌株是否与需要支持的药物相关 血流动力学。在目标2中，我将确定冠状动脉搭桥术后回声应变减少的机制。 心肌灌注的对比增强回声和流量计将被用来测试与 心功能改变(回声应变)。我还将评估MAG是否会导致心肌灌注低于 Will基于SAG的血运重建。在目标3中，我将确定回声应变的减少是否可以预测 6个月后的临床结果优于常规影像指标。通过研究两者之间的联系 血管重建技术，心脏功能和生理学，我将为研究生涯奠定基础 将有关心功能障碍潜在机制的新见解转化为有意义的麻醉剂 改善临床结果的干预措施。在Devereux博士强大的指导团队(广泛 心血管成像试验和心脏结局研究方面的专业知识)，Gaudino(国际知名 心脏外科医生，专注于多动脉移植并设计随机临床试验和m-pI 资助的父母试验(Roma)和WeinSaft(定量心脏成像和翻译研究方面的专家)， 我将能够提高我的临床研究技能，同时获得新的高级技术技能 超声心动图和翻译研究，这将使我成为一名独立的调查员。在……里面 此外，从我的K23获得的新技能将直接指导计划中的R01到(A)的设计，以评估LV 冠状动脉搭桥术患者对血管活性药物改善移植动脉血流的反应和(B)试验 血管扩张剂治疗以改善MAG患者的临床结果。

Project Summary Coronary artery disease (CAD) is a leading cause of morbidity and mortality: revascularization via coronary artery bypass grafting (CABG) is a common therapy for CAD, which is performed via either single arterial graft (SAG) or multiple arterial grafting (MAG) strategies. Whereas arterial grafts have better long-term patency than vein grafts, data indicates that patients receiving MAG may experience higher perioperative risk. Cardiac function is known to predict prognosis after CABG, but the impact of different revascularization approaches on cardiac performance and consequences on clinical outcomes are incompletely understood. In this re- submission K23 proposal, I will build on my background in cardiothoracic anesthesia and advanced echo imaging to elucidate the effect of the two different revascularization strategies (SAG vs. MAG) on cardiac function immediately after CABG and subsequent clinical outcomes, in order to provide a framework for perioperative management of CABG patients. In Aim 1, I will examine the impact of CABG revascularization strategy on the change in cardiac function defined by echo strain. I will identify if MAG will result in lower cardiac performance as quantified by transesophageal echocardiography from baseline to after the operation. I will also evaluate whether the change echo strain will be associated with medications need to support hemodynamics. In Aim 2, I will determine the mechanism by which echo strain decreases after CABG. Myocardial perfusion on contrast-enhanced echo and flowmeter will be utilized to test the association with cardiac functional change (echo strain). I will also evaluate if MAG will result in lower myocardial perfusion than will SAG-based revascularization. In Aim 3, I will determine whether the decrease in echo strain predicts clinical outcomes at 6 months better than conventional imaging indices. By studying the link between revascularization techniques, cardiac function and physiology, I will lay the groundwork for a research career translating new insights regarding underlying mechanisms of cardiac dysfunction into meaningful anesthetic interventions that improve clinical outcomes. Under my strong mentorship team of Drs. Devereux (extensive expertise in cardiovascular imaging trials and cardiac outcomes research), Gaudino (internationally renowned cardiac surgeon with a focus on multi-arterial grafting and designing randomized clinical trials and m-PI of the funded parent trial ROMA), and Weinsaft (an expert in quantitative cardiac imaging and translational research), I will be able to enhance my clinical research skills while obtaining new technical skills advanced echocardiography and translational research that will allow me to become an independent investigator. In addition, new skills obtained from my K23 will directly guide the design of a planned R01 to (a) to assess LV response to vasoactive medications designed to improve arterial graft flow in CABG patients and (b) test vasodilator therapy to improve clinical outcomes in patients with MAG.