Efficacy of Coronary Artery Bypass Grafting in Patients With a Dilated Left Ventricle due to Myocardial Infarction

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概要

• 論文の詳細を見る

• This study was designed to clarify the efficacy of coronary artery bypass grafting(CABG)on left ventricular(LV)function in 16 patients with a dilated LV due to myocardial infarction(LV end-systolic volume index:LVESVI>60ml/m^2). All had attained complete revascularization. To estimate the LV wall motion quantitatively using echocardiography, a wall motion score(WMS)was used(LV was divided into 17 segments with a four-point scale:akinesis=3, severe hypokinesis=2, hypokinesis=1, normal=0 and then summed). Exercise stress tests were performed after surgery, revealing that anginal symptoms had vanished in all the patients. In 5 patients with a preoperative end-systolic volume index(ESVI)>100ml/m^2, the ejection fraction(EF)did not change, and both were under 30%(before to after:26±4 to 26±4%). Neither the ESVI(148±50 to 133±39ml/m^2)nor the end-diastolic volume index(end-diastolic volume index(EDVI):198±62 to 180±37ml/m^2)changed;the WMS did not change(33±2 to 33±3). During exercise, in spite of the increase in heart rate(HR)(at rest, 81±20;HR during exercise, 111±21 beats/min, p<0.005)and LV end-diastolic pressure(EDP)(22±9;35±13mmHg, p<0.02), both cardiac index(CI)(2.4±0.3;2.6±0.4 L/min・m^2)and minute work(MW:4.0±1.1;4.1±0.4kg・M/min)did not increase. In 11 patients with a preoperative ESVI<100ml/m^2, EF was extremely increased in 5 patients(more than 10%, 35±4 to 60±6%, p<0.005=improved subgroup)in whom the EDVI(130±16 to 120±13ml/m^2)did not change whereas the ESVI(82±14 to 48±7ml/m^2)was reduced. However, in the 6 remaining patients(ie nonimproved subgroup), neither ESVI(78±8 to 74±12ml/m^2), EDVI(115±10 to 115±20ml/m^2)nor EF(31±7 to 35±3%)changed. During exercise, HR(at rest, 88±13;during exercise, 108±11 beats/min, p<0.005), LVEDP(20±6;29±7mmHg, p<0.01), CI(2.5±0.6;3.3±0.5L/min・m^2, p<0.05), MW(4.6±1.0;6.5±1.5kg・M/min, p<0.05)increased. The WMS in the nonimproved subgroup did not change(29±6 to 27±2), but in the improved subgroup it reduced after surgery(27±3 to 19±4, p<0.01). These data suggested that CABG in patients with a dilated LV was effective against anginal symptoms, but was restricted to left ventricular function. It may be possible to estimate postoperative LV function, including exercise tolerance, from the preoperative LVESVI.

• 社団法人日本循環器学会の論文
• 1998-07-20

著者

• Sakai Kei

  Heart Science Centre Harefield Hospital Imperial College Faculty Of Medicine

• Nakano Susumu

  Department Of Advanced Cardiovascular Therapeutics Osaka University Graduate School Of Medicine

• NAKANO Susumu

  Division of Cardiovascular Surgery, Rinku General Medical Center

• Hirata Nobuaki

  Department Of Surgery Course Of Interventional Medicine (e1) Osaka University Graduate School Of Med

• HIRATA NOBUAKI

  Division of Cardiovascular Surgery and Cardiovascular Division, Osaka Police Hospital

• Hoki Noritake

  First Dept. of Med. Osaka Univ. Med. School

• Sakai Kei

  Division of Cardiac Surgery, Sakurabashi Watanabe Hospital

• Ohtani Masakatsu

  Division of Cardiac Surgery, Sakurabashi Watanabe Hospital

• Sakaki Shigehiko

  Division of Cardiac Surgery, Sakurabashi Watanabe Hospital

• Ohnishi Kenji

  Division of Cardiac Surgery, Sakurabashi Watanabe Hospital

• Miyamoto Yuji

  Division of Cardiac Surgery, Sakurabashi Watanabe Hospital

• Matsuda Hikaru

  Division of Cardiac Surgery, Sakurabashi Watanabe Hospital

• MIYAMOTO Yuji

  Department of Cardiovascular Surgery, Hyogo College of Medicine

• Ohnishi Kenji

  Division Of Cardiac Surgery Sakurabashi Watanabe Hospital:first Department Of Surgery Osaka Universi

• Miyamoto Yuji

  Department Of Cardiovascular Surgery Hyogo College Of Medicine

• Hirata Nobuaki

  The First Department Of Surgery Osaka University Medical School

• Onishi Kenji

  First Dept. Of Surgery Osaka Unlv School Of Med

• Kuki Satoru

  First Department Of Surgery Osaka University Medical School

• Sakai Kei

  First Department Of Surgery Osaka University Medical School

• Sakaki Shigehiko

  Division Of Cardiac Surgery Sakurabashi Watanabe Hospital:first Department Of Surgery Osaka Universi

• Ohtani Masakatsu

  Division Of Cardiac Surgery Sakurabashi Watanabe Hospital:first Department Of Surgery Osaka Universi

• Nakano Susumu

  Division Of Biological Science Faculty Of Commercial Science Hiroshima Shudo University

• Hirata Nobuaki

  Division Of Cardiology Osaka General Medical Center

• Nakano S

  Division Of Life Science Faculty Of Commercial Sciences Hiroshima Shudo University

• Ohnishi Kenji

  First Department Of Surgery Osaka University Hospital

• Sato Kunitomo

  Division Of Cardiology Sakurabashi Watanabe Hospital

• Satoh Kunitomo

  Cardiovascular Division Sakurabashi Watanebe Hospital

• Miyamoto Yuji

  Osaka university graduate school of medicine

• Otani Masakatsu

  First Department Of Surgery Osaka University Medical School

• Sato Shigeo

  Department Of Cardiovascular Surgery Sakurabashi Watanabe Hospital

• Matsuda Hikaru

  香川大学 総合診療部

• Miyamoto Yuji

  First Department Of Surgery Osaka University Medical School

• Suzuki Ken

  First Department Of Surgery Osaka University Medical School

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