Functional Recovery After Coronary Artery Bypass Grafting in Patients With Severe Left Ventricular Dysfunction and Preserved Myocardial Viability in the Left Anterior Descending Arterial Territory as Assessed by Thallium-201 Myocardial Perfusion Imaging

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To evaluate the functional recovery after-coronary bypass surgery in patients with severe left ventricular(LV)dysfunction(ejection fraction(EF)≤35%), 100 consecutive patients with viable myocardium in the territory supplied by the left anterior descending artery(LAD)underwent coronary bypass grafting. In addition, cardiac catheterization and single-photon emission computed tomography(SPECT)perfusion imaging with thallium-201 were repeated 1-year postoperatively. Although 12 patients with severa LV dysfunction were preoperatively in a worse New York Heart Association functional class(3.1±0.7 vs 2.4±0.8;p<0.01), had a higher incidence of heart failure(10/12 vs 14/88;p<0.001)and had a worse LVEF(29±5 vs 61±14%;p<0.001)compared with 88 patients without severe LV dysfunction, the operative mortality was similar in the 2 groups(1/12 vs 2/88;p=NS). The postoperative NYHA functional class in the patients with severe LV dysfunction was similar to that in the patients without such dysfunction(1.6±0.7 vs 1.3±0.6;p=NS). In addition, the 1-year postoperative study revealed a significant improvement in the thallium defect score in both the LAD territory(1.7±1.2 to 0.7±1.0, p=0.01)and all the territories(5.2±2.2 to 3.2±1.9, p=0.02)in patients with severe LV dysfunction, whereas no improvement in defect score was found in either of these territories in those without severe LV dysfunction (LAD:0.6±1.4 to 0.4±1.2, p=NS;All:1.9±2.2 to 1.8±2.0, p=NS). Furthermore, a marked 1-year postoperative improvement(15-24%;95% confidence interval)in LVEF(29±5 to 48±10%, p<0.001)was demonstrated in patients with severe LV dysfunction, but not in those without such dysfunction(60±13 to 61±11%, p=NS). These results indicate that myocardial viability in the LAD territory, as demonstrated by thallium-201 SPECT perfusion imaging, predicts a significant improvement in functional class and LVEF of at least 10% or more after coronary artery bypass grafting in patients with severe LV dysfunction.
社団法人日本循環器学会の論文
1999-09-20

Functional Recovery After Coronary Artery Bypass Grafting in Patients With Severe Left Ventricular Dysfunction and Preserved Myocardial Viability in the Left Anterior Descending Arterial Territory as Assessed by Thallium-201 Myocardial Perfusion Imaging

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