Hibernating myocardium: clinical and functional response to revascularisation
| Autor: | T. P. Chua, Dudley J. Pennell, CJ Knight, Mark Gunning, Keith A.A. Fox, S. R. Underwood, John Pepper, D. Harrington, E. Burman |
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| Rok vydání: | 1997 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine Hibernation medicine.medical_specialty medicine.medical_treatment Revascularization Coronary artery disease Ventricular Dysfunction Left Oxygen Consumption Internal medicine medicine Humans Prospective Studies Derivation Coronary Artery Bypass Aged Myocardial Stunning Tomography Emission-Computed Single-Photon Hibernating myocardium Exercise Tolerance Ejection fraction business.industry General Medicine Middle Aged medicine.disease Magnetic Resonance Imaging Thallium Radioisotopes medicine.anatomical_structure Bypass surgery Cardiology Female Surgery medicine.symptom Cardiology and Cardiovascular Medicine business Artery |
| Zdroj: | European Journal of Cardio-Thoracic Surgery. 11:1105-1112 |
| ISSN: | 1010-7940 |
| DOI: | 10.1016/s1010-7940(97)01211-6 |
| Popis: | Objective: We assessed the effects of coronary bypass grafting on left ventricular (LV) function, exercise capacity and symptom profile in patients with LV impairment and evaluated the role of identifying myocardial hibernation in a prospective non-randomised study. Methods: Of 120 patients screened, 47 patients with LV ejection fraction B 35% and three vessel coronary artery disease were studied. All underwent stress:redistribution and separate day rest:redistribution Tl-201 imaging together with cine MRI at enrolment, and cine MRI at follow-up. Group 1, 30 patients undergoing bypass surgery, underwent symptom limited treadmill exercise testing with peak VO2 measurement, and symptom profile evaluation less than 3 months before, and 3‐6 months after operation. Revascularisation was assessed by post-operative Tl-201 imaging and repeat coronary angiography. Group 2, 17 patients treated on medical therapy alone underwent symptom profile assessment at enrolment and follow-up for those who survived. Segmental hibernation was defined as the equivalent of greater than 50% of maximal Tl-201 uptake where wall motion was severely impaired on resting imaging. Patients were considered to be hibernating where two of nine LV segments fulfilled these criteria. Results: In group 1, five patients died (17%), peri-or post-operatively, two defaulted and 23 attended follow-up studies. In group 2, three patients died prior to follow-up (18%). In the surgical group there was an increase in mean LVEF from 24.098% to 29.7911% (PB0.05) while in the medical group there was a fall from 25.79 10% to 20.698% (PB0.05). In group 1, the mean NYHA dyspnoea grade improved from 2.7 to 1.4 while in the medical group it was unchanged, 2.6 to 2.5. In patients with myocardial hibernation identified pre-operatively, 18:19 (95%) improved LVEF after CABG compared with 2:4 (50%) of patients without hibernation. 17:19 (86%) patients with hibernation improved NYHA dyspnoea class compared with 2:4 (50%) of patients without. 60:93 (65%) of hibernating segments improved function after revascularisation while 47:53 (89%) hibernating segments showed no improvement on medical therapy alone. Conclusion: In patients with severe LV impairment with myocardial hibernation, coronary artery bypass grafting improves both global and regional systolic LV function, and symptom profile. Medical treatment of patients with LV impairment and myocardial hibernation does not improve LV contractile function or symptoms. Both surgical and medical therapy carry a high mortality rate. © 1997 Elsevier Science B.V. |
| Databáze: | OpenAIRE |
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