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

被引:29
作者
Depre, C
Vanoverschelde, JLJ
Gerber, B
Borgers, M
Melin, JA
Dion, R
机构
[1] UNIV CATHOLIQUE LOUVAIN, SCH MED, DIV CARDIOVASC SURG, B-1200 BRUSSELS, BELGIUM
[2] UNIV CATHOLIQUE LOUVAIN, SCH MED, POSITRON EMISS TOMOG LAB, B-1200 BRUSSELS, BELGIUM
[3] JANSSEN RES FDN, B-2340 BEERSE, BELGIUM
关键词
D O I
10.1016/S0022-5223(97)70335-0
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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.
引用
收藏
页码:371 / 378
页数:8
相关论文
共 21 条
[1]  
[Anonymous], 1982, Lancet, V2, P1173
[2]   CHRONIC ISCHEMIC VIABLE MYOCARDIUM IN MAN - ASPECTS OF DEDIFFERENTIATION [J].
AUSMA, J ;
SCHAART, G ;
THONE, F ;
SHIVALKAR, B ;
FLAMENG, W ;
DEPRE, C ;
VANOVERSCHELDE, JL ;
RAMAEKERS, F ;
BORGERS, M .
CARDIOVASCULAR PATHOLOGY, 1995, 4 (01) :29-37
[3]   DIRECT COMPARISON OF [N-13] AMMONIA AND [O-15]WATER ESTIMATES OF PERFUSION WITH QUANTIFICATION OF REGIONAL MYOCARDIAL BLOOD-FLOW BY MICROSPHERES [J].
BOL, A ;
MELIN, JA ;
VANOVERSCHELDE, JL ;
BAUDHUIN, T ;
VOGELAERS, D ;
DEPAUW, M ;
MICHEL, C ;
LUXEN, A ;
LABAR, D ;
COGNEAU, M ;
ROBERT, A ;
HEYNDRICKX, GR ;
WIJNS, W .
CIRCULATION, 1993, 87 (02) :512-525
[4]   STRUCTURAL CORRELATES OF REGIONAL MYOCARDIAL DYSFUNCTION IN PATIENTS WITH CRITICAL CORONARY-ARTERY STENOSIS - CHRONIC HIBERNATION [J].
BORGERS, M ;
THONE, F ;
WOUTERS, L ;
AUSMA, J ;
SHIVALKAR, B ;
FLAMENG, W .
CARDIOVASCULAR PATHOLOGY, 1993, 2 (04) :237-245
[5]   REVERSIBLE ISCHEMIC LEFT-VENTRICULAR DYSFUNCTION - EVIDENCE FOR THE HIBERNATING MYOCARDIUM [J].
BRAUNWALD, E ;
RUTHERFORD, JD .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1986, 8 (06) :1467-1470
[6]   STRUCTURAL AND METABOLIC CORRELATES OF THE REVERSIBILITY OF CHRONIC LEFT-VENTRICULAR ISCHEMIC DYSFUNCTION IN HUMANS [J].
DEPRE, C ;
VANOVERSCHELDE, JLJ ;
MELIN, JA ;
BORGERS, M ;
BOL, A ;
AUSMA, J ;
DION, R ;
WIJNS, W .
AMERICAN JOURNAL OF PHYSIOLOGY-HEART AND CIRCULATORY PHYSIOLOGY, 1995, 268 (03) :H1265-H1275
[7]   PREOPERATIVE PREDICTION OF THE OUTCOME OF CORONARY REVASCULARIZATION USING POSITRON EMISSION TOMOGRAPHY [J].
DESILVA, R ;
YAMAMOTO, Y ;
RHODES, CG ;
IIDA, H ;
NIHOYANNOPOULOS, P ;
DAVIES, GJ ;
LAMMERTSMA, AA ;
JONES, T ;
MASERI, A .
CIRCULATION, 1992, 86 (06) :1738-1742
[8]   MULTIVARIATE-ANALYSIS OF ANGIOGRAPHIC, HISTOLOGIC, AND ELECTROCARDIOGRAPHIC DATA IN PATIENTS WITH CORONARY HEART-DISEASE [J].
FLAMENG, W ;
WOUTERS, L ;
SERGEANT, P ;
LEWI, P ;
BORGERS, M ;
THONE, F ;
SUY, R .
CIRCULATION, 1984, 70 (01) :7-17
[9]  
GAMBHIR SS, 1989, J NUCL MED, V30, P359
[10]   DEPENDENCE OF RECOVERY OF CONTRACTILE FUNCTION ON MAINTENANCE OF OXIDATIVE-METABOLISM AFTER MYOCARDIAL-INFARCTION [J].
GROPLER, RJ ;
SIEGEL, BA ;
SAMPATHKUMARAN, K ;
PEREZ, JE ;
SOBEL, BE ;
BERGMANN, SR ;
GELTMAN, EM .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1992, 19 (05) :989-997