冠状动脉血运重建术对左心室收缩功能严重减低患者左心室重构及收缩功能的作用

Effects of Coronary Revascularization on Left Ventricular Remodeling Attenuation and Its Systolic Function in Patients With Severe Left Ventricular Dysfunction

目的评价冠状动脉血运重建术对陈旧性心肌梗死伴左心室收缩功能严重减低患者的左心室重构及整体和节段收缩功能的改善作用。方法对陈旧性心肌梗死伴左心室收缩功能严重减低(左心室射血分数039±005),并证明病变部位有存活心肌的患者26例,均完成冠状动脉血运重建术,其中冠状动脉旁路移植术12例,经皮冠状动脉腔内成形术+支架14例。于冠状动脉血运重建术前、后[平均(68±29)月]进行二维超声心动图检查,评价左心室容积及整体和节段收缩功能的变化,并完成术后临床随访。结果26例患者冠状动脉血运重建术后与术前相比,574%的运动异常节段(156/272)有收缩运动改善;术后平均左心室舒张末容积(LVEDV)和收缩末容积(LVESV)均显著缩小(P<005～001),而左心室射血分数和室壁节段运动评分指数均显著改善(P均<0001);随访期间的临床症状和NYHA心功能分级亦均明显改善,无心脏事件发生。去除4例行室壁瘤切除者后,各指标的变化与上述相同。再以冠状动脉血运重建术后左心室射血分数增加≥005与否分为心功能改善者和心功能无改善者各11例,心功能改善者的LVEDV和LVESV均较术前显著缩小(P均<001),心功能无改善者两参数较术前均无明显扩大。此外,术后功能改善的节段数与术后左心室射血分数呈显著正相关(r=051,P<001);而术后功能无?

Objective:To evaluate the effects of coronary revascularization (CRV) on improvement in left ventricular remodeling attenuation and its segmental and global systolic function in patients with old myocardial infarction and severe left ventricular dysfunction. Methods:Twenty six patients with old myocardial infarction and severe left ventricular dysfunction(mean left ventricular ejection fraction[LVEF]0 39±0 05)underwent CRV,including coronary bypass surgery in 12 and coronary balloon angioplasty plus stenting in 14 patients.Two dimensional echocardiography was examined in every patient before and in a mean period of 6 8± 2 9 months after CRV to evaluate left ventricular volume,regional and global systolic function changes Clinical follow up was also done. Results:Among the 272 abnormal segments in 26 patients,156 segments (57 4%) showed improvement in contractile function after CRV.Compared with the baseline before CRV,both LVEDV and LVESV were significantly decreased ( p <0 05—0 01),and both LVEF and wall motion score index (WMSI) were significantly improved (both p <0 05).The clinical symptoms and NYHA functional classes were also improved in all patients.There was no new cardiac event occurring within the follow up period.Excluding 4 patients with left ventricular aneurysmectomy,and using an cut off of ≥0 05 and <0 05 in post CRV LVEF,global function was found improved in 11 and unimproved in 11.In improvement group,the LVEDV and LVESV were both significantly decreased (both p <0 01),and the LVEF and the WMSI were both significantly increased (both p <0 001).In unimprovement group after CRV,the indexes were not significantly changed (all p <0 05).Moreover,There was a positive correlation between the number of functional improved segments and the magnitude of LVEF after CRV ( r =0 51, p <0 01); while the number of functional unimproved segments after CRV was significantly larger in LVEF unimprovement group than in improvement group ( p <0 05). Conclusion:The patients with myocardial infarction and severe left ventricular dysfunction can benefit from CRV,either in left ventricular remodeling attenuation and prevention,or in segmental and global function improvements and improved symptoms.The number of functionally improved segments after CRV is positively correlated with the improvement of LVEF,while the number of unimproved segments is probably related to the unimproved LVEF.