冬眠心肌的评估对外科再血管化的临床意义

Clinical Value of Evaluating Hibernating Myocardium for Surgical Revascularization

冠心病致左心功能不全又称为缺血性心肌病(ICM),临床上是指因冠状动脉狭窄或堵塞导致的难治性左心室功能不全(LVEF≤35%或40%)。已有研究表明大部分缺血性心肌病患者存在冬眠心肌,经冠状动脉旁路移植手术(CABG)可恢复冬眠心肌的收缩力,一定程度上改善射血分数及心衰症状。一些临床检查方法能评估慢性缺血性心功能不全患者的冬眠心肌范围、指导外科再血管化治疗。近5年的一些研究结果均提示对有冬眠心肌的患者行外科再血管化可以改善患者心肌收缩功能、改善心衰症状。在此,我们对冬眠心肌的主要临床评估方法及其对外科再血管化的临床意义作出综述。

Left ventricular dysfunction as a result of coronary artery disease,also known as ischemic cardiomyopathy（ICM）,has been used to describe a clinically refractory left ventricular dysfunction caused by coronary artery stenosis or occlusion（left ventricular ejection fraction,LVEF ≤ 35% to 40%）. It has been proved by previous researches that hibernating myocardium（HM） exists in most patients with ICM,and coronary artery bypass grafting（CABG） surgery can improve the contractility of the HM,heart failure related symptoms,and LVEF. Some clinical examination methods can guide the treatment of revascularization for ICM patients by evaluating extent of HM. Some researches in the past 5 years have shown that patients with hibernating myocardium can benefit from surgical revasuclarization to improve their systolic function of myocardium and heart failure related symptoms. We summarize the clinical methods of HM evaluation and their clinical values for surgical revascularization for patients with ICM.