术前冬眠心肌占比对冠心病合并严重左心功能不全患者行不停跳冠状动脉旁路移植术后左心功能改善的预测价值  

Value of preoperative proportion of hibernating myocardium to the prediction of left heart function improvement after off-pump coronary artery bypass grafting in patients with coronary heart disease and severe left ventricular dysfunction

作　　者：黄功成 舒礼良[1] 黄辰[1] 朱效华[1] 徐敬[1] HUANG Gongcheng;SHU Liliang;HUANG Chen;ZHU Xiaohua;XU Jing(Department of Cardiac Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China)

机构地区：[1]郑州大学第一附属医院心脏外科,河南郑州450052

出　　处：《中华实用诊断与治疗杂志》2024年第4期331-335,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金(82300314)。

摘　　要：目的观察冠心病合并严重左心功能不全患者术前冬眠心肌占左心室心肌百分比(冬眠心肌占比),探讨其对患者行不停跳冠状动脉旁路移植术(OPCAB)后左心功能改善的预测价值。方法2020年6月—2022年6月郑州大学第一附属医院诊治冠心病合并严重左心功能不全患者46例,均行OPCAB,比较术前与术后3个月时左室射血分数(LVEF)、左心室舒张末期容积。根据术后3个月时LVEF较术前改善情况分为改善组(术后改善LVEF≥5%)34例和未改善组(术后改善LVEF<5%)12例,比较2组术前冬眠心肌占比、心房颤动比率等临床资料。采用多因素logistic回归分析冠心病合并严重左心功能不全患者行OPCAB后左心功能改善的影响因素;绘制ROC曲线,评估术前冬眠心肌占比预测冠心病合并严重左心功能不全患者行OPCAB后左心功能改善的效能。结果46例患者术后3个月时LVEF[(37.7±5.6)%]高于术前[(28.7±3.9)%](t=-8.991,P=0.023),左心室舒张末期容积[(177.0±13.7)mL]与术前[(192.6±12.4)mL]比较差异无统计学意义(t=5.737,P=0.814)。改善组术前冬眠心肌占比[(18.9±4.0)%]高于未改善组[(12.1±3.4)%](χ^(2)=5.640,P<0.001),心房颤动比率(11.8%)低于未改善组(66.7%)(χ^(2)=-5.737,P<0.001)。术前冬眠心肌占比是冠心病合并严重左心功能不全患者行OPCAB后左心功能改善的影响因素(OR=2.449,95%CI:1.299~4.617,P=0.006)。术前冬眠心肌占比以16.5%为最佳截断值,预测冠心病合并严重左心功能不全患者行OPCAB后左心功能改善的AUC为0.911(95%CI:0.819~1.000,P<0.001),灵敏度为73.5%,特异度为91.7%。结论术前冬眠心肌占比较高、无心房颤动的冠心病合并严重左心功能不全患者行OPCAB后左心功能改善的概率增大,术前冬眠心肌占比对患者行OPCAB后左心功能改善的预测价值较高。Objective To observe the preoperative proportion of hibernating myocardium in left ventricular myocardium in patients with coronary heart disease complicated with severe left ventricular dysfunction,and to explore its value to the prediction of left heart function improvement after off-pump coronary artery bypass grafting(OPCAB).Methods From June 2020 to June 2022,46 patients with coronary heart disease complicated with severe left ventricular dysfunction received OPCAB in the First Affiliated Hospital of Zhengzhou University.The left ventricular ejection fraction(LVEF)and left ventricular end-diastolic volume(LVEDV)were compared before and 3 months after OPCAB.The LVEF 3 months after OPCAB was improved≥5%in 34 patients(improvement group)and<5%in 12 patients(non-improvement group),and the clinical data such as the preoperative proportion of hibernating myocardium and the ratio of atrial fibrillation were compared between two groups.Multivariate logistic regression analysis was used to assess the influencing factors of left heart function improvement after OPCAB in patients with coronary heart disease and severe left ventricular dysfunction.The ROC curves were plotted to evaluate the efficiency of preoperative proportion of hibernating myocardium on improving left heart function after OPCAB.Results In 46 patients,the LVEF was significantly higher 3 months after OPCAB[(37.7±5.6)%]than that before OPCAB[(28.7±3.9)%](t=-8.991,P=0.023),and the LVEDV showed no significant difference 3 months after OPCAB[(177.0±13.7)mL]compared with that before OPCAB[(192.6±12.4)mL](t=5.737,P=0.814).The proportion of hibernating myocardium before OPCAB was higher in improvement group[(18.9±4.0)%]than that in non-improvement group[(12.1±3.4)%](x^(2)=5.640,P<0.001),and the ratio of atrial fibrillation was lower in improvement group(11.8%)than that in non-improvement group(66.7%)(x^(2)=-5.737,P<0.001).The preoperative proportion of hibernating myocardium was an influencing factor of left heart function improvement after OPCAB(OR=2.

关 键 词：冠心病 左心功能不全 不停跳冠状动脉旁路移植术 冬眠心肌 

分 类 号：R654.2[医药卫生—外科学]