Single-territory incomplete surgical revascularization improves regional wall motion of remote ventricular areas： results from a propensity-matched study

ObjectiveBasic 科学研究表明了为帮助心肌的功能的一个 microvascular neocapillaries 网络的创造潜在地负责的一般 intramyocardial angiogenetic 回答。我们假设了利益由领土和生物 angiogenetic 驱动器由 revascularization 触发了的左前面的下降的灌注(男孩)提供了，这能在室的收缩性在全球改进翻译，没与 multivessel 限制为 grafted area.MethodsHigh风险病人冠的动脉疾病和外科手术前的墙运动畸形回顾地被分析比较结果和收到了最佳的 m 的那些的地区性的室的功能从 2007 年 1 月到 2014 年 12 月， 206 个病人(OMT， n = 136， OPCABG， n = 70 ) 匹配有 70 的倾向分数被匹配对。在倾向 20 分析包括的变量是喷射部分(EF ) ，左室的结束心脏舒张的体积(LVEDVi ) ， EuroSCORE II。主要端点是在全球墙运动分数索引(WMSI ) 的变化是由 transthoracic echocardiography 评估了。列在后面在上面从外科在 3 年被完成或室的功能的医院 discharge.ResultsRegional 分析不仅为男孩领土而且为非男孩区域在 OPCABG 组揭示了地区性的 WMSI 改进，在改变的否定左室的 ischemic 与减小联系了，在最佳的医药治疗与病人相比排出。全球 WMSI 在 OPCABG 组是否定的(-3.4 ? 牦浯愠瀠潲数獮瑩 ? 慭' 謹?瑳摵 y 吗？？

Objective Basic science studies demonstrated a general intramyocardial angiogenetic response potentially responsible for the creation of a microvascular neocapillaries network assisting myocardial function. We hypothesized that the benefit provided by the reperfusion of left anterior descending （LAD） territories and the biological angiogenetic drive triggered by the revascularization could translate in a global improvement in ventricular contractility, not restricted to the grafted area. Methods High-risk patients with multivessel coronary artery disease and preoperative wall motion abnormalities were retrospectively analyzed to compare outcomes and regional ventricular function of those who received optimal medical therapy （OMT） versus those who underwent off-pump coronary artery bypass grafting （OPCABG） and received an incomplete myocardial revascularization using left internal mammary artery （LIMA） on LAD （OPCABG group）. From January 2007 to December 2014, 206 patients （OMT, n = 136, OPCABG, n = 70） were propensity-score matched to have 70 matched pairs. Variables included in propensity score analyses were ejection fraction （EF）, left ventricular end diastolic volume （LVEDVi）, EuroSCORE II. Primary endpoint was the variation in the global wall motion score index （AWMSI） as evaluated by transthoracic echocardiography. Follow up was completed at 3 years from surgery or hospital discharge. Results Regional analysis of ventricular function revealed a regional WMSI improvement in the OPCABG group not only for LAD territories but also for non-LAD regions, associated with a reduction in the negative left ventricular ischemic remodeling, compared to patients discharged in optimal medical therapy. Global AWMSI was negative in OPCABG group （-3.4 ± 2.8%） and positive in the OMT group （5.9 ± 3.1%）, indicating a better wall motion score for OPCAB patients. Surprisingly, regional WMSI improved also in non-grafted territories in the off-pump CABG group with a delta value of -3.7 ± 5.3% for left circumflex artery （LCX） area and -3.5 ± 5.4% for right coronary artery （RCA） area. Conclusions In patients with multivessel coronary artery disease, LIMA-to-LAD grafting is associated with an improvement in the WMSI involving also the surrounding non-LAD ungrafted segments and with the attenuation of negative global and regional ischemic ventricular remodeling.