Background: Post-stress ejection fraction (EF), end-dia-stolic (EDV) and en d-systolic (ESV) volumes by gated myocardial perfusion SPECT (MPS) are well val idated, reproducible and of prognostic significance. However,...Background: Post-stress ejection fraction (EF), end-dia-stolic (EDV) and en d-systolic (ESV) volumes by gated myocardial perfusion SPECT (MPS) are well val idated, reproducible and of prognostic significance. However, little is known ab out the impact of percutaneous coronary intervention (PCI) on left ventricular v olumes and remodeling. Methods: Thirty-eight patients who underwent MPS before and 6 months after PCI were evaluated. MPS were interpreted deriving summed stre ss(SSS), rest(SRS) and difference(SDS=SSS-SRS; extent of ischemia) scores. EF, EDV and ESV were generated by QGSTM. Pre-PCI MPS were compared to post-PCI MPS . Results: Single vessel disease was present in 63%of patients. PCI of one vess el was performed in 82%of patients. After 6 months, SSS (10.6±6.3 vs. 2.8±4.3 , p< 0.001) and SDS(8.2±5.6 vs. 1.4±2.3, p< 0.001) had improved; however, EF d id not change significantly(55±10 vs. 57±13, p=ns). Still, EDV(105±25 ml vs. 96±25 ml, p=0.006) and ESV(49±19 ml vs. 41±18 ml, p=0.001) were significantly reduced. Conclusion: Results of MPS documented the beneficial effect of PCI on symptoms and extent of ischemia. In addition, the findings showed a significant decrease in ESV and EDV after PCI as compared to pre-PCI findings which points to a positive effect on left ventricular remodeling even in the absence of signi ficant changes in EF.展开更多
Objective Surgical left ventricular restoration by means of endoventricular patch aneurysmectomy in patients with postinfarction aneurysm should result in acute improved left ventricular performance by decreasing mech...Objective Surgical left ventricular restoration by means of endoventricular patch aneurysmectomy in patients with postinfarction aneurysm should result in acute improved left ventricular performance by decreasing mechanical dyssynchrony and increasing energy efficiency. MethodsNine patients with left ventricular postinfarction aneurysm were studied intraoperatively before and after ventricular restoration with a conductance volume catheter to analyze pressure-volume relationships, energy efficiency, and mechanical dyssynchrony. The end-systolic elastance was used as a load-independent index of contractile state. Left ventricular energy efficiency was calculated from stroke work and total pressure-volume area. Segmental volume changes perpendicular to the long axis were used to calculate mechanical dyssynchrony. Statistical analysis was performed with the paired t test and least-squares linear regression. Results Endoventricular patch aneurysmectomy reduced end-diastolic volume by 37%(P < .001), with unchanged stroke volume. Systolic function improved, as derived from increased +dP/dtmax, by 42%(P < .03), peak ejection rate by 28%(P < .02), and ejection fraction by 16%(P < .0002). Early diastolic function improved, as shown by reduction of-dP/dtmax by 34%(P < .006)and shortened τby 30%(P< .001). Left ventricular end-systolic elastance increased from 1.2±0.6 to 2.2±1 mm Hg/mL(P < .001). Left ventricular energy efficiency increased by 36%(P < .002). Left ventricular mechanical dyssynchrony decreased during systole by 33%(P < .001)and during diastole by 20%(P < .005). Conclusions Left ventricular restoration induced acute improvements in contractile state, energy efficiency, and relaxation, together with a decrease in left ventricular mechanical dyssynchrony.展开更多
文摘Background: Post-stress ejection fraction (EF), end-dia-stolic (EDV) and en d-systolic (ESV) volumes by gated myocardial perfusion SPECT (MPS) are well val idated, reproducible and of prognostic significance. However, little is known ab out the impact of percutaneous coronary intervention (PCI) on left ventricular v olumes and remodeling. Methods: Thirty-eight patients who underwent MPS before and 6 months after PCI were evaluated. MPS were interpreted deriving summed stre ss(SSS), rest(SRS) and difference(SDS=SSS-SRS; extent of ischemia) scores. EF, EDV and ESV were generated by QGSTM. Pre-PCI MPS were compared to post-PCI MPS . Results: Single vessel disease was present in 63%of patients. PCI of one vess el was performed in 82%of patients. After 6 months, SSS (10.6±6.3 vs. 2.8±4.3 , p< 0.001) and SDS(8.2±5.6 vs. 1.4±2.3, p< 0.001) had improved; however, EF d id not change significantly(55±10 vs. 57±13, p=ns). Still, EDV(105±25 ml vs. 96±25 ml, p=0.006) and ESV(49±19 ml vs. 41±18 ml, p=0.001) were significantly reduced. Conclusion: Results of MPS documented the beneficial effect of PCI on symptoms and extent of ischemia. In addition, the findings showed a significant decrease in ESV and EDV after PCI as compared to pre-PCI findings which points to a positive effect on left ventricular remodeling even in the absence of signi ficant changes in EF.
文摘Objective Surgical left ventricular restoration by means of endoventricular patch aneurysmectomy in patients with postinfarction aneurysm should result in acute improved left ventricular performance by decreasing mechanical dyssynchrony and increasing energy efficiency. MethodsNine patients with left ventricular postinfarction aneurysm were studied intraoperatively before and after ventricular restoration with a conductance volume catheter to analyze pressure-volume relationships, energy efficiency, and mechanical dyssynchrony. The end-systolic elastance was used as a load-independent index of contractile state. Left ventricular energy efficiency was calculated from stroke work and total pressure-volume area. Segmental volume changes perpendicular to the long axis were used to calculate mechanical dyssynchrony. Statistical analysis was performed with the paired t test and least-squares linear regression. Results Endoventricular patch aneurysmectomy reduced end-diastolic volume by 37%(P < .001), with unchanged stroke volume. Systolic function improved, as derived from increased +dP/dtmax, by 42%(P < .03), peak ejection rate by 28%(P < .02), and ejection fraction by 16%(P < .0002). Early diastolic function improved, as shown by reduction of-dP/dtmax by 34%(P < .006)and shortened τby 30%(P< .001). Left ventricular end-systolic elastance increased from 1.2±0.6 to 2.2±1 mm Hg/mL(P < .001). Left ventricular energy efficiency increased by 36%(P < .002). Left ventricular mechanical dyssynchrony decreased during systole by 33%(P < .001)and during diastole by 20%(P < .005). Conclusions Left ventricular restoration induced acute improvements in contractile state, energy efficiency, and relaxation, together with a decrease in left ventricular mechanical dyssynchrony.
