Relationship between myocardial viability and early application of intra-aortic balloon pump after coronary artery bypass grafting_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Lu ¹ , HU Yijin ¹ , LI Jianming ² , WANG Jiao ² ,  WANG Hongwu ¹

1. Department of Anesthesiology, TEDA International Cardiovascular Hospital, Tianjin University, Tianjin, 300457, P. R. China;
2. Department of Nuclear Medicine, TEDA International Cardiovascular Hospital, Tianjin University, Tianjin, 300457, P. R. China;

Corresponding author：

WANG Hongwu, Email: wanghw1967@163.com

Keywords：

Coronary artery disease; coronary artery bypass grafting; myocardial viability by PET-CT; intra-aortic balloon pump

DOI：

10.7507/1007-4848.202106050

Video：

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Objective To explore the relationship between myocardial viability in patients with coronary artery disease who underwent elective coronary artery bypass grafting (CABG) and early application of intra-aortic balloon pump (IABP) after coronary revascularization, and to provide relevant clinical reference for the pre-implantation of 16G single-lumen catheter in the femoral artery of high-risk patients to facilitate the addition of IABP after operation.Methods This retrospective study included 521 patients (414 males and 107 females, aged 62.50±8.82 years) who underwent positron emission tomography (PET)-computed tomography (CT) perfusion-metabolism imaging prior to CABG surgery in our institution from December 2015 to August 2020. The myocardial viability information and left ventricular functional parameters were measured, including the proportion of non-viable myocardium (perfusion-metabolic imaging match), hibernating myocardium (perfusion-metabolic imaging mismatch) and dysfunctional myocardium (non-viable+viable myocardium), left ventricular ejection fraction, left ventricular end-diastolic volume and left ventricular end-systolic volume (LVESV). The patients were divided into an IABP group and a non-IABP group according to whether they received IABP treatment after revascularization. The clinical data were reviewed and compared to explore significant impact factors between the two groups. And the multivariate logistic regression analysis was performed to investigate the correlation between preoperative myocardial viability and early use of IABP after CABG.Results In multivariate logistic regression analysis, the amount of non-viable, dysfunctional myocardium and LVESV value were identified as the independent predictors for the probability of IABP use in the initial postoperative period. Receiver operating characteristic analysis showed that 9.5% non-viable myocardium, 19.5% dysfunctional myocardium, and LVESV of 114.5 mL were the optimal cutoff for predicting early IABP implantation during CABG.Conclusion The myocardial survival status displayed by preoperative PET-CT myocardial perfusion-metabolism imaging can predict the possibility of applying IABP in CABG perioperative period. In addition to routine pre-anesthesia assessment, anesthesiologists can conduct risk stratification assessment for patients with CABG according to the results of preoperative myocardial viability imaging, which is of great significance to ensure the perioperative safety of high-risk patients with CABG.

Citation： ZHANG Lu, HU Yijin, LI Jianming, WANG Jiao, WANG Hongwu. Relationship between myocardial viability and early application of intra-aortic balloon pump after coronary artery bypass grafting. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(3): 396-402. doi: 10.7507/1007-4848.202106050 Copy

1.	Zhang F, Wang J, Shao X, et al. Incremental value of myocardial wall motion and thickening to perfusion alone by gated SPECT myocardial perfusion imaging for viability assessment in patients with ischemic heart failure. J Nucl Cardiol, 2021, 28(6): 2545-2556.
2.	Malhotra S, Gomez J, Doukky R. Assessment of myocardial viability using single-photon emission computed tomography myocardial perfusion imaging. Curr Opin Cardiol, 2019, 34(5): 473-483.
3.	吴清玉, 许建屏, 高长青, 等. 冠状动脉旁路移植术技术指南. 中华外科杂志, 2006, 44(22): 1517-1524.
4.	孙笑天, 庞烈文. 冠状动脉旁路移植术的现况与展望. 上海医药, 2012, 33(2): 11-14, 20.
5.	Dilsizian V, Bacharach SL, Beanlands RS, et al. ASNC imaging guidelines/SNMMI procedure standard for positron emission tomography (PET) nuclear cardiology procedures. J Nucl Cardiol, 2016, 23(5): 1187-1226.
6.	孙茉茉, 李剑明, 刘志刚. 冠状动脉旁路移植术前13N-NH3/18F-FDG PET显像测冬眠心肌的临床研究. 中国医学影像技术, 2018, 34(7): 1003-1008.
7.	付春华. 主动脉内球囊反搏泵的临床应用进展. 心血管病学进展, 2014, 35(2): 265-268.
8.	吴冬冬, 刘志刚, 李剑明, 等. 心肌活力预测缺血性心力衰竭患者冠状动脉旁路移植术后心功能改善的临床研究. 中国胸心血管外科临床杂志, 2020, 27(11): 1314-1319.
9.	杨彦松, 张晓膺, 王跃涛, 等. 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. 中华胸心血管外科杂志, 2016, 32(5): 279-282.
10.	中华医学会心血管病学分会影像学组, 中国医师协会放射医师分会心血管专业委员会. 无创性心血管影像学技术临床适用标准中国专家共识. 中华心血管病杂志, 2020, 48(11): 906-921.
11.	孙茉茉, 李剑明, 刘志刚. PET/CT检测冠状动脉旁路移植术患者存活心肌的研究进展. 医学综述, 2017, 23(16): 3291-3295, 3301.
12.	中华医学会核医学分会中华医学会心血管病学分会. 核素心肌显像临床应用指南 (2018). 中华心血管病杂志, 2019, 47(7): 519-527.
13.	Khalaf S, Chamsi-Pasha M, Al-Mallah MH. Assessment of myocardial viability by PET. Curr Opin Cardiol, 2019, 34(5): 466-472.
14.	Madsen S, Dias AH, Lauritsen KM, et al. Myocardial viability testing by positron emission tomography: Basic concepts, mini-review of the literature and experience from a tertiary PET center. Semin Nucl Med, 2020, 50(3): 248-259.
15.	Kerkhof PLM, van de Ven PM, Yoo B, et al. Ejection fraction as related to basic components in the left and right ventricular volume domains. Int J Cardiol, 2018, 255: 105-110.
16.	Huttin O, Mandry D, Eschalier R, et al. Cardiac remodeling following reperfused acute myocardial infarction is linked to the concomitant evolution of vascular function as assessed by cardiovascular magnetic resonance. J Cardiovasc Magn Reson, 2017, 19(1): 2.
17.	Bolognese L, Neskovic AN, Parodi G, et al. Left ventricular remodeling after primary coronary angioplasty: Patterns of left ventricular dilation and long-term prognostic implications. Circulation, 2002, 106(18): 2351-2357.
18.	Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart disease and stroke statistics-2017 update: A report from the American Heart Association. Circulation, 2017, 135(10): e146-e603.
19.	Boden WE, Brooks WW, Conrad CH, et al. Incomplete, delayed functional recovery late after reperfusion following acute myocardial infarction: "Maimed myocardium". Am Heart J, 1995, 130(4): 922-932.
20.	Ramos M, DePasquale E, Coplan NL. Assessment of myocardial viability: Review of the clinical significance. Rev Cardiovasc Med, Fall 2008, 9(4): 225-231.
21.	Parissis H, Soo A, Al-Alao B. Intra-aortic balloon pump (IABP): From the old trends and studies to the current "extended" indications of its use. J Cardiothorac Surg, 2012, 7: 128.
22.	He XY, Gao CQ. Peri-operative application of intra-aortic balloon pumping reduced in-hospital mortality of patients with coronary artery disease and left ventricular dysfunction. Chin Med J (Engl), 2019, 132(8): 935-942.
23.	Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: A report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation, 2011, 124(23): e652-e735.
24.	何潇一, 王嵘, 高长青, 等. 冠状动脉粥样硬化性心脏病伴轻度左心功能不全患者围术期应用主动脉内球囊反搏早中期结果分析. 中国体外循环杂志, 2018, 16(1): 16-20, 11.
25.	Lehtinen M, Schildt J, Ahonen A, et al. Combining FDG-PET and 99mTc-SPECT to predict functional outcome after coronary artery bypass surgery. Eur Heart J Cardiovasc Imaging, 2015, 16(9): 1023-1030.
26.	Ali US, Lan NSR, Gilfillan M, et al. Preoperative intra-aortic balloon pumps in cardiac surgery: A propensity score analysis. Heart Lung Circ, 2021, 30(5): 758-764.
27.	Gunnarsdóttir SLX, Gunnarsdóttir ELT, Heimisdottir AA, et al. The use of intra aortic balloon pump in coronary artery bypass graft surgery. Laeknabladid, 2020, 106(2): 63-70.
28.	Jannati M, Attar A. Intra-aortic balloon pump postcardiac surgery: A literature review. J Res Med Sci, 2019, 24: 6.
29.	姜睿, 胡盛寿, 田月琴, 等. 局部心肌存活状态与冠状动脉旁路移植术后远期心血管事件的关系. 中国循环杂志, 2009, 24(1): 24-27.

1. Zhang F, Wang J, Shao X, et al. Incremental value of myocardial wall motion and thickening to perfusion alone by gated SPECT myocardial perfusion imaging for viability assessment in patients with ischemic heart failure. J Nucl Cardiol, 2021, 28(6): 2545-2556.
2. Malhotra S, Gomez J, Doukky R. Assessment of myocardial viability using single-photon emission computed tomography myocardial perfusion imaging. Curr Opin Cardiol, 2019, 34(5): 473-483.
3. 吴清玉, 许建屏, 高长青, 等. 冠状动脉旁路移植术技术指南. 中华外科杂志, 2006, 44(22): 1517-1524.
4. 孙笑天, 庞烈文. 冠状动脉旁路移植术的现况与展望. 上海医药, 2012, 33(2): 11-14, 20.
5. Dilsizian V, Bacharach SL, Beanlands RS, et al. ASNC imaging guidelines/SNMMI procedure standard for positron emission tomography (PET) nuclear cardiology procedures. J Nucl Cardiol, 2016, 23(5): 1187-1226.
6. 孙茉茉, 李剑明, 刘志刚. 冠状动脉旁路移植术前13N-NH3/18F-FDG PET显像测冬眠心肌的临床研究. 中国医学影像技术, 2018, 34(7): 1003-1008.
7. 付春华. 主动脉内球囊反搏泵的临床应用进展. 心血管病学进展, 2014, 35(2): 265-268.
8. 吴冬冬, 刘志刚, 李剑明, 等. 心肌活力预测缺血性心力衰竭患者冠状动脉旁路移植术后心功能改善的临床研究. 中国胸心血管外科临床杂志, 2020, 27(11): 1314-1319.
9. 杨彦松, 张晓膺, 王跃涛, 等. 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. 中华胸心血管外科杂志, 2016, 32(5): 279-282.
10. 中华医学会心血管病学分会影像学组, 中国医师协会放射医师分会心血管专业委员会. 无创性心血管影像学技术临床适用标准中国专家共识. 中华心血管病杂志, 2020, 48(11): 906-921.
11. 孙茉茉, 李剑明, 刘志刚. PET/CT检测冠状动脉旁路移植术患者存活心肌的研究进展. 医学综述, 2017, 23(16): 3291-3295, 3301.
12. 中华医学会核医学分会中华医学会心血管病学分会. 核素心肌显像临床应用指南 (2018). 中华心血管病杂志, 2019, 47(7): 519-527.
13. Khalaf S, Chamsi-Pasha M, Al-Mallah MH. Assessment of myocardial viability by PET. Curr Opin Cardiol, 2019, 34(5): 466-472.
14. Madsen S, Dias AH, Lauritsen KM, et al. Myocardial viability testing by positron emission tomography: Basic concepts, mini-review of the literature and experience from a tertiary PET center. Semin Nucl Med, 2020, 50(3): 248-259.
15. Kerkhof PLM, van de Ven PM, Yoo B, et al. Ejection fraction as related to basic components in the left and right ventricular volume domains. Int J Cardiol, 2018, 255: 105-110.
16. Huttin O, Mandry D, Eschalier R, et al. Cardiac remodeling following reperfused acute myocardial infarction is linked to the concomitant evolution of vascular function as assessed by cardiovascular magnetic resonance. J Cardiovasc Magn Reson, 2017, 19(1): 2.
17. Bolognese L, Neskovic AN, Parodi G, et al. Left ventricular remodeling after primary coronary angioplasty: Patterns of left ventricular dilation and long-term prognostic implications. Circulation, 2002, 106(18): 2351-2357.
18. Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart disease and stroke statistics-2017 update: A report from the American Heart Association. Circulation, 2017, 135(10): e146-e603.
19. Boden WE, Brooks WW, Conrad CH, et al. Incomplete, delayed functional recovery late after reperfusion following acute myocardial infarction: "Maimed myocardium". Am Heart J, 1995, 130(4): 922-932.
20. Ramos M, DePasquale E, Coplan NL. Assessment of myocardial viability: Review of the clinical significance. Rev Cardiovasc Med, Fall 2008, 9(4): 225-231.
21. Parissis H, Soo A, Al-Alao B. Intra-aortic balloon pump (IABP): From the old trends and studies to the current "extended" indications of its use. J Cardiothorac Surg, 2012, 7: 128.
22. He XY, Gao CQ. Peri-operative application of intra-aortic balloon pumping reduced in-hospital mortality of patients with coronary artery disease and left ventricular dysfunction. Chin Med J (Engl), 2019, 132(8): 935-942.
23. Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: A report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation, 2011, 124(23): e652-e735.
24. 何潇一, 王嵘, 高长青, 等. 冠状动脉粥样硬化性心脏病伴轻度左心功能不全患者围术期应用主动脉内球囊反搏早中期结果分析. 中国体外循环杂志, 2018, 16(1): 16-20, 11.
25. Lehtinen M, Schildt J, Ahonen A, et al. Combining FDG-PET and 99mTc-SPECT to predict functional outcome after coronary artery bypass surgery. Eur Heart J Cardiovasc Imaging, 2015, 16(9): 1023-1030.
26. Ali US, Lan NSR, Gilfillan M, et al. Preoperative intra-aortic balloon pumps in cardiac surgery: A propensity score analysis. Heart Lung Circ, 2021, 30(5): 758-764.
27. Gunnarsdóttir SLX, Gunnarsdóttir ELT, Heimisdottir AA, et al. The use of intra aortic balloon pump in coronary artery bypass graft surgery. Laeknabladid, 2020, 106(2): 63-70.
28. Jannati M, Attar A. Intra-aortic balloon pump postcardiac surgery: A literature review. J Res Med Sci, 2019, 24: 6.
29. 姜睿, 胡盛寿, 田月琴, 等. 局部心肌存活状态与冠状动脉旁路移植术后远期心血管事件的关系. 中国循环杂志, 2009, 24(1): 24-27.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Relationship between myocardial viability and early application of intra-aortic balloon pump after coronary artery bypass grafting

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