A clinical study of myocardial viability in predicting the improvement of cardiac function after coronary artery bypass grafting in patients with ischemic heart failure_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WU Dongdong ¹ , LIU Zhigang ¹ , LI Jianming ² , FAN Guoliang ³ , DING Tong ⁴ ,  LIU Xiaocheng ¹

1. Department of Cardiac Surgery, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300457, P.R.China;
2. Department of Nuclear Medicine, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300457, P.R.China;
3. Intensive Care Unit, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300457, P.R.China;
4. Department of Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100037, P.R.China;

Corresponding author：

LIU Xiaocheng, Email: liuxc@tedaich.com

Keywords：

Ischemic heart failure; coronary artery bypass grafting (CABG); myocardial viability; prognosis

DOI：

10.7507/1007-4848.202003073

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Objective To explore the predictive value of myocardial vitality in the improvement of cardiac function after coronary artery bypass grafting (CABG) in patients with ischemic heart failure.Methods From December 8, 2015 to November 12, 2018, 46 patients with ischemic heart failure who underwent CABG operation alone were collected retrospectively. There were 41 males and 5 females with an average age of 60.4±8.0 years. The myocardial vitality and number of different types of myocardium were measured. The clinical data of patients in the left ventricular ejection fraction (LVEF) improvement group (≥5%) and non-improvement group (<5%) were compared and analyzed. The correlation between each index and LVEF improvement was analyzed by logistic multivariate regression analysis, and the boundary value of hibernating myocardium between LVEF improvement and non-improvement was obtained by receiver operating characteristic (ROC) curve.Results There were significant differences in the number of hibernating myocardium (15.0%±12.3% vs. 4.3%±4.5%, P=0.000), the number of normal myocardium (74.7%±13.7% vs. 82.4%±8.6%, P=0.027), and cardiac function classification (NYHA) development (−0.7±0.7 vs. −0.3±0.5, P=0.047) between the two groups, but there was no significant difference in other indexes between the two groups (P>0.05). Logistic regression analysis showed that the number of hibernating myocardium was an independent factor affecting the improvement of LVEF after CABG in patients with ischemic heart failure (OR=1.366, 95%CI 1.033-1.807, P=0.029). The ROC curve showed that the threshold value, sensitivity and specificity of hibernating myocardium were 15.0%, 43.8% and 100.0%, respectively.Conclusion The percentage of hibernating myocardium to left ventricular wall area ≥15.0% can accurately predict the improvement of LVEF in patients with ischemic heart failure after CABG. Preoperative myocardial vitality assessment has important diagnostic value in predicting the improvement of cardiac function in patients with ischemic heart failure after simple CABG.

Citation： WU Dongdong, LIU Zhigang, LI Jianming, FAN Guoliang, DING Tong, LIU Xiaocheng. A clinical study of myocardial viability in predicting the improvement of cardiac function after coronary artery bypass grafting in patients with ischemic heart failure. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(11): 1314-1319. doi: 10.7507/1007-4848.202003073 Copy

1.	Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation, 2017, 136(6): 137-161.
2.	Cremer P, Hachamovitch R, Tamarappoo B. Clinical decision making with myocardial perfusion imaging in patients with known or suspected coronary artery disease. Semin Nucl Med, 2014, 44(4): 320-329.
3.	Partington SL, Kwong RY, Dorbala S. Multimodality imaging in the assessment of myocardial viability. Heart Fail Rev, 2011, 16(4): 381-395.
4.	杨彦松. 存活心肌数量预测冠状动脉旁路移植术后左心室射血分数改善和左心室容积减小的价值. 苏州大学, 2016.
5.	Peovska I, Maksimovic J, Vavlukis M, et al. Functional outcome and quality of life after coronary artery bypass surgery in patients with severe heart failure and hibernated myocardium. Nucl Med Commun, 2008, 29(3): 215-221.
6.	Serruys PW, Morice MC, Kappetein AP, et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med, 2009, 360(10): 961-972.
7.	Farkouh ME, Domanski M, Sleeper LA, et al. Strategies for multivessel revascularization in patients with diabetes. N Engl J Med, 2012, 367(25): 2375-2384.
8.	Frangogiannis NG, Shimoni S, Chang SM, et al. Active interstitial remodeling: An important process in the hibernating human myocardium. J Am Coll Cardiol, 2002, 39(9): 1468-1474.
9.	Bonow RO, Maurer G, Lee KL, et al. Myocardial viability and survival in ischemic left ventricular dysfunction. N Engl J Med, 2011, 364(17): 1617-1625.
10.	Shah BN, Khattar RS, Senior R. The hibernating myocardium: Current concepts, diagnostic dilemmas, and clinical challenges in the post-STICH era. Eur Heart J, 2013, 34(18): 1323-1336.
11.	Brunelli C, Parodi O, Sambuceti G, et al. Improvement of hibernation in the clinical setting. J Mol Cell Cardiol, 1996, 28(12): 2415-2418.
12.	Hocum Stone LL, Swingen C, Holley C, et al. Magnetic resonance imaging assessment of cardiac function in a swine model of hibernating myocardium 3 months following bypass surgery. J Thorac Cardiovasc Surg, 2017, 153(3): 582-590.
13.	Schinkel AF, Poldermans D, Vanoverschelde JL, et al. Incidence of recovery of contractile function following revascularization in patients with ischemic left ventricular dysfunction. Am J Cardiol, 2004, 93(1): 14-17.
14.	D'Egidio G, Nichol G, Williams KA, et al. Increasing benefit from revascularization is associated with increasing amounts of myocardial hibernation: A substudy of the PARR-2 trial. JACC Cardiovasc Imaging, 2009, 2(9): 1060-1068.
15.	Sarikaya I. Cardiac applications of PET. Nucl Med Commun, 2015, 36(10): 971-985.
16.	Lehner S, Sussebach C, Todica A, et al. Influence of SPECT attenuation correction on the quantification of hibernating myocardium as derived from combined myocardial perfusion SPECT and ¹⁸F-FDG PET. J Nucl Cardiol, 2014, 21(3): 578-587.
17.	Task Force members, Windecker S, Kolh P, et al. 2014 ESC/EACTS guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J, 2014, 35(37): 2541-2619.
18.	Dibble EH, Yoo DC. Precision medicine and PET/computed tomography in cardiovascular disorders. PET Clin, 2017, 12(4): 459-473.
19.	Athanasuleas CL, Buckberg GD, Stanley AW, et al. Surgical ventricular restoration in the treatment of congestive heart failure due to post-infarction ventricular dilation. J Am Coll Cardiol, 2004, 44(7): 1439-1445.

1. Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation, 2017, 136(6): 137-161.
2. Cremer P, Hachamovitch R, Tamarappoo B. Clinical decision making with myocardial perfusion imaging in patients with known or suspected coronary artery disease. Semin Nucl Med, 2014, 44(4): 320-329.
3. Partington SL, Kwong RY, Dorbala S. Multimodality imaging in the assessment of myocardial viability. Heart Fail Rev, 2011, 16(4): 381-395.
4. 杨彦松. 存活心肌数量预测冠状动脉旁路移植术后左心室射血分数改善和左心室容积减小的价值. 苏州大学, 2016.
5. Peovska I, Maksimovic J, Vavlukis M, et al. Functional outcome and quality of life after coronary artery bypass surgery in patients with severe heart failure and hibernated myocardium. Nucl Med Commun, 2008, 29(3): 215-221.
6. Serruys PW, Morice MC, Kappetein AP, et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med, 2009, 360(10): 961-972.
7. Farkouh ME, Domanski M, Sleeper LA, et al. Strategies for multivessel revascularization in patients with diabetes. N Engl J Med, 2012, 367(25): 2375-2384.
8. Frangogiannis NG, Shimoni S, Chang SM, et al. Active interstitial remodeling: An important process in the hibernating human myocardium. J Am Coll Cardiol, 2002, 39(9): 1468-1474.
9. Bonow RO, Maurer G, Lee KL, et al. Myocardial viability and survival in ischemic left ventricular dysfunction. N Engl J Med, 2011, 364(17): 1617-1625.
10. Shah BN, Khattar RS, Senior R. The hibernating myocardium: Current concepts, diagnostic dilemmas, and clinical challenges in the post-STICH era. Eur Heart J, 2013, 34(18): 1323-1336.
11. Brunelli C, Parodi O, Sambuceti G, et al. Improvement of hibernation in the clinical setting. J Mol Cell Cardiol, 1996, 28(12): 2415-2418.
12. Hocum Stone LL, Swingen C, Holley C, et al. Magnetic resonance imaging assessment of cardiac function in a swine model of hibernating myocardium 3 months following bypass surgery. J Thorac Cardiovasc Surg, 2017, 153(3): 582-590.
13. Schinkel AF, Poldermans D, Vanoverschelde JL, et al. Incidence of recovery of contractile function following revascularization in patients with ischemic left ventricular dysfunction. Am J Cardiol, 2004, 93(1): 14-17.
14. D'Egidio G, Nichol G, Williams KA, et al. Increasing benefit from revascularization is associated with increasing amounts of myocardial hibernation: A substudy of the PARR-2 trial. JACC Cardiovasc Imaging, 2009, 2(9): 1060-1068.
15. Sarikaya I. Cardiac applications of PET. Nucl Med Commun, 2015, 36(10): 971-985.
16. Lehner S, Sussebach C, Todica A, et al. Influence of SPECT attenuation correction on the quantification of hibernating myocardium as derived from combined myocardial perfusion SPECT and ¹⁸F-FDG PET. J Nucl Cardiol, 2014, 21(3): 578-587.
17. Task Force members, Windecker S, Kolh P, et al. 2014 ESC/EACTS guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J, 2014, 35(37): 2541-2619.
18. Dibble EH, Yoo DC. Precision medicine and PET/computed tomography in cardiovascular disorders. PET Clin, 2017, 12(4): 459-473.
19. Athanasuleas CL, Buckberg GD, Stanley AW, et al. Surgical ventricular restoration in the treatment of congestive heart failure due to post-infarction ventricular dilation. J Am Coll Cardiol, 2004, 44(7): 1439-1445.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

A clinical study of myocardial viability in predicting the improvement of cardiac function after coronary artery bypass grafting in patients with ischemic heart failure

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