Objective Basic science studies demonstrated a general intramyocardial angiogenetic response potentially responsible for the creation of a microvascular neocapillaries network assisting myocardial function. We hypothe...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.展开更多
Background Postconditioning has been shown to reduce infarct size, ischemic/reperfusion injury and myocardial injury in patients with acute myocardial infarction （AMI） undergoing percutaneous coronary intervention ...Background Postconditioning has been shown to reduce infarct size, ischemic/reperfusion injury and myocardial injury in patients with acute myocardial infarction （AMI） undergoing percutaneous coronary intervention （PCI）. This study tested the hypothesis that postconditioning attenuates the elevation of tumor necrosis factor-a （TNF-a） and improves heart function in patients with AMI after PCI. Methods A total of 75 patients were randomly assigned to 1 of 3 groups： the routine group （n=-26）, in which no intervention was given at the onset of reperfusion; and the Postcon-30s （n=25） or Postcon-60 s （n=24） groups, in which 3 cycles of 30- or 60-second balloon deflation and inflation were repetitively performed. TNF-a serum concentration was measured by ELISA. Global and regional left ventricular systolic function was determined by echocardiography at 1 year. Thirty-four normal controls （NC） were enrolled in the study. Results The TNF-a concentration in patients with AMI was significantly elevated at baseline compared to controls （P 〈0.01）. Concentration levels increased in the routine and Postcon-30s, but not in Postcon-60s group at 7 days （P 〈0.05）. As for linear associations among the three groups, left ventricular ejection fraction （LVEF） and wall motion score index （WMSI） were ranked as follows： Postcon-60s 〉Postcon-30s〉routine （P values all 〈0.05, 65% vs. 57% vs. 52% and 1.10 vs. 1.27 vs. 1.53） after 1 year. More importantly, there was a significant relevance between the soluble TNF-a serum concentration at 7 days and LVEF or WMSI after 1 year （Pvalues all 〈0.0001）. Conclusions Postconditioning, in particular Postcon-60s was associated with long-term cardioprotective effects for inhibition of the inflammatory response and reperfusion injury. The soluble TNF-a serum concentration provided powerful prognostic information of global and regional left ventricular systolic function in patients with AMI.展开更多
文摘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.
文摘Background Postconditioning has been shown to reduce infarct size, ischemic/reperfusion injury and myocardial injury in patients with acute myocardial infarction （AMI） undergoing percutaneous coronary intervention （PCI）. This study tested the hypothesis that postconditioning attenuates the elevation of tumor necrosis factor-a （TNF-a） and improves heart function in patients with AMI after PCI. Methods A total of 75 patients were randomly assigned to 1 of 3 groups： the routine group （n=-26）, in which no intervention was given at the onset of reperfusion; and the Postcon-30s （n=25） or Postcon-60 s （n=24） groups, in which 3 cycles of 30- or 60-second balloon deflation and inflation were repetitively performed. TNF-a serum concentration was measured by ELISA. Global and regional left ventricular systolic function was determined by echocardiography at 1 year. Thirty-four normal controls （NC） were enrolled in the study. Results The TNF-a concentration in patients with AMI was significantly elevated at baseline compared to controls （P 〈0.01）. Concentration levels increased in the routine and Postcon-30s, but not in Postcon-60s group at 7 days （P 〈0.05）. As for linear associations among the three groups, left ventricular ejection fraction （LVEF） and wall motion score index （WMSI） were ranked as follows： Postcon-60s 〉Postcon-30s〉routine （P values all 〈0.05, 65% vs. 57% vs. 52% and 1.10 vs. 1.27 vs. 1.53） after 1 year. More importantly, there was a significant relevance between the soluble TNF-a serum concentration at 7 days and LVEF or WMSI after 1 year （Pvalues all 〈0.0001）. Conclusions Postconditioning, in particular Postcon-60s was associated with long-term cardioprotective effects for inhibition of the inflammatory response and reperfusion injury. The soluble TNF-a serum concentration provided powerful prognostic information of global and regional left ventricular systolic function in patients with AMI.
