| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 1997;64:1694-1701
© 1997 The Society of Thoracic Surgeons
Departments of Cardiac Surgery, Cardiology, Biostatistics, and Nuclear Medicine, Katholieke Universiteit Leuven, Leuven, Belgium
Accepted for publication May 30, 1997.
Background. Viable but hypocontractile myocardium can show functional improvement after revascularization (hibernation). It is sometimes difficult, however, to predict viability and recovery in patients with severe left ventricular function. This study sought to identify possible predictive factors of recovery of cardiac function after revascularization in patients with three-vessel disease.
Methods. Positron emission tomography (fluoro-18-deoxyglucose uptake for metabolism; nitrogen 13–labeled ammonia for flow) and equilibrium-gated nuclear angiography (for the global ejection fraction) were performed in 59 patients with three-vessel disease before and after undergoing coronary artery bypass grafting. The positron emission tomographic data were expressed as match normal (flow and metabolism normal), mismatch (low flow, high metabolism), match viable (moderate decrease in flow and metabolism), and match necrosis (low flow and metabolism).
Results. Stepwise logistic regression analysis showed that only mismatch regions played a significant role in predicting postoperative improvement in function (p = 0.019). There were 1.7 ± 1.5 mismatch regions in 31 patients who showed an improvement in their ejection fraction (0.47 ± 0.14 versus 0.58 ± 0.11; mean ± standard deviation) versus 0.8 ± 1.0 mismatch regions (p = 0.017) in patients who did not show recovery. There was more pronounced functional improvement with increasing numbers of mismatch regions, and patients with at least one mismatch region had a high likelihood of recovery (p < 0.001). In patients with a very low preoperative ejection fraction and two or more mismatch regions, there was early significant recovery (0.27 ± 0.08 versus 0.46 ± 0.06; p = 0.009).
Conclusions. At least one mismatch region must be present for there to be a postoperative functional benefit. When a low left ventricular ejection fraction is associated with mismatch, early recovery is substantial.
Related Article
Ann. Thorac. Surg. 1997 64: 1701.
This article has been cited by other articles:
|
|
 |
|
  S. H. Rahimtoola, V. Dilsizian, C. M. Kramer, T. H. Marwick, and J.-L. J. Vanoverschelde Chronic Ischemic Left Ventricular Dysfunction: From Pathophysiology to Imaging and its Integration Into Clinical Practice J. Am. Coll. Cardiol. Img., July 1, 2008; 1(4): 536 - 555. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. B. Jacklin, S. F. Barrington, J. C. Roxburgh, G. Jackson, D. Sariklis, P. A. West, and M. N. Maisey Cost-effectiveness of preoperative positron emission tomography in ischemic heart disease Ann. Thorac. Surg., May 1, 2002; 73(5): 1403 - 1409. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H.-M. J. Siebelink, P. K. Blanksma, H. J. G. M. Crijns, J. J. Bax, A. J. van Boven, T. Kingma, D. A. Piers, J. Pruim, P. L. Jager, W. Vaalburg, et al. No difference in cardiac event-free survival between positron emission tomography-guided and single-photon emission computed tomography-guided patient management: A prospective, randomized comparison of patients with suspicion of jeopardized myocardium J. Am. Coll. Cardiol., January 1, 2001; 37(1): 81 - 88. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 O. Jegaden, L. Bontemps, G. de Gevigney, A. Eker, P. Montagna, C. Chatel, R. Itti, and P. Mikaeloff Does the extended used of arterial grafts compromise the myocardial recovery after coronary artery bypass grafting in left ventricular dysfunction? Eur. J. Cardiothorac. Surg., October 1, 1999; 14(4): 353 - 359. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
