Impact of Myocardial Viability on Long-term Outcomes after Surgical Revascularization.

IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Thoracic and Cardiovascular Surgeon Pub Date : 2024-09-01 Epub Date: 2023-12-13 DOI:10.1055/a-2228-7104
Suk Ho Sohn, Yoonjin Kang, Ji Seong Kim, Eun-Ah Park, Whal Lee, Ho Young Hwang
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Abstract

Background:  This study was conducted to evaluate whether myocardial viability assessed with cardiac magnetic resonance (CMR) affected long-term clinical outcomes after coronary artery bypass grafting (CABG) in patients with ischemic cardiomyopathy (ICMP).

Methods:  Preoperative CMR with late gadolinium enhancement (LGE) was performed in 103 patients (64.9 ± 10.1 years, male:female = 82:21) with 3-vessel disease and left ventricular dysfunction (ejection fraction ≤ 0.35). Transmural extent of LGE was evaluated on a 16-segment model, and transmurality was graded on a 5-point scale: grades-0, absence; 1, 1 to 25%; 2, 26 to 50%; 3, 51 to 75%; 4, 76 to 100%. Median follow-up duration was 65.5 months (interquartile range = 27.5-95.3 months). Primary endpoint was the composite of all-cause mortality or hospitalization for congestive heart failure.

Results:  Operative mortality was 1.9%. During the follow-up, all-cause mortality and readmission for congestive heart failure occurred in 29 and 8 patients, respectively. The cumulative incidence of the primary endpoint was 31.3 and 46.8% at 5 and 10 years, respectively. Multivariable analysis demonstrated that the number of segments with LGE grade 4 was a significant risk factor (hazard ratio 1.42, 95% confidence interval 1.10-1.83, p = 0.007) for the primary endpoint among the variables assessed by CMR. Other risk factors included age, dialysis, chronic obstructive pulmonary disease, and EuroSCORE II.

Conclusion:  The number of myocardial segments with transmurality of LGE >75% might be a prognostic factor associated with the composite of all-cause mortality or hospitalization for congestive heart failure after CABG in patients with 3-vessel disease and ICMP.

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心肌活力对手术血管重建后长期疗效的影响
研究背景本研究旨在评估心脏磁共振评估的心肌活力是否会影响缺血性心肌病患者冠状动脉旁路移植术(CABG)后的长期临床预后:方法:对103例(64.9±10.1岁,男女比例为82:21)患有三支血管疾病和左心室功能障碍(射血分数≤0.35)的患者进行术前心脏磁共振晚期钆增强(LGE)检查。LGE的透壁范围在16段模型上进行评估,透壁性按5级评分:0级,无;1级,1%-25%;2级,26%-50%;3级,51%-75%;4级,76%-100%。中位随访时间为 65.5 个月(四分位间范围 = 27.5-95.3 个月)。主要终点为全因死亡率或因充血性心力衰竭住院的复合终点:结果:手术死亡率为1.9%。随访期间,分别有29名和8名患者因全因死亡和充血性心力衰竭再次入院。5年和10年后,主要终点的累积发生率分别为31.3%和46.8%。多变量分析表明,在心脏磁共振评估的变量中,LGE 4 级的节段数是主要终点的重要风险因素(危险比 1.42,95% 置信区间 1.10-1.83,P =.007)。其他风险因素包括年龄、透析、慢性阻塞性肺病和EuroSCORE II:结论:LGE透射率大于75%的心肌节段数量可能是与三血管疾病和缺血性心肌病患者接受CABG手术后全因死亡或因充血性心力衰竭住院的综合结果相关的预后因素。
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来源期刊
CiteScore
3.40
自引率
6.70%
发文量
365
审稿时长
3 months
期刊介绍: The Thoracic and Cardiovascular Surgeon publishes articles of the highest standard from internationally recognized thoracic and cardiovascular surgeons, cardiologists, anesthesiologists, physiologists, and pathologists. This journal is an essential resource for anyone working in this field. Original articles, short communications, reviews and important meeting announcements keep you abreast of key clinical advances, as well as providing the theoretical background of cardiovascular and thoracic surgery. Case reports are published in our Open Access companion journal The Thoracic and Cardiovascular Surgeon Reports.
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