IMPROVEMENT OF SEVERELY REDUCED LEFT-VENTRICULAR FUNCTION AFTER SURGICAL REVASCULARIZATION IN PATIENTS WITH PREOPERATIVE MYOCARDIAL-INFARCTION

被引：80

作者：

CARREL, T

JENNI, R

HAUBOLDREUTER, S

VONSCHULTHESS, G

PASIC, M

TURINA, M

机构：

[1] Clinic for Cardiovascular Surgery, University Hospital, Zurich

[2] Department of Medicine, University Hospital, Zurich

[3] Institute of Nuclear Medicine, University Hospital, Zurich

来源：

EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY | 1992年 / 6卷 / 09期

关键词：

CORONARY ARTERY DISEASE; LEFT VENTRICULAR IMPAIRMENT; SURGICAL REVASCULARIZATION; POSITRON EMISSION TOMOGRAPHY;

D O I：

10.1016/1010-7940(92)90244-R

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

In recent years, two pathophysiological conditions - stunned and hibernating myocardium - have been described showing how function may be depressed in myocardium that remains viable. The aims of the present study were postoperative assessment of LV function at rest and during exercise after CABG in patients with established previous myocardial infarction and impaired preoperative LV function and evaluation of preliminary experience with positron emission tomography (PET) in the preoperative identification of reversible ischaemic myocardium and its predictivity in postoperative functional improvement. We studied 23 patients with preoperative LV function under 45%. Echocardiography and complete heart catheter were performed pre- and postoperatively. PET was performed in all patients preoperatively. In 21 patients with patent grafts, CABG significantly improved systolic and diastolic function during exercise and at rest. EF improved from 34% +/- 14% to 52% +/- 11 % at rest and from 31% +/- 14% to 58% +/- 13% during exercise (P < 0.01). Time constant of diastolic relaxation was significantly reduced after revascularization. In 2 patients with pathological findings on postoperative coronarangiography, EF remained unchanged. Both global and regional contractility improved following surgery. Regional analysis indicated that improved EF at rest occurred in regions developing ischaemia during exercise before CABG and in regions showing typical mismatch in Rubidium-82-2-fluro-2-desoxyglucose suggesting the presence of hibernating myocardium. Patients with CAD and LV dysfunction at rest can demonstrate significant improvement of LV function after CABG due to restoration of normal coronary blood flow in ischaemic but still viable myocardial areas. Although not available yet in clinical routine, PET seems to be useful in the prediction of functional improvement of asynergic and hypokinetic myocardial segments after revascularization.

引用

页码：479 / 484

页数：6

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