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Titolo:
Time course of functional recovery after coronary artery bypass graft surgery in patients with chronic left ventricular ischemic dysfunction
Autore:
Vanoverschelde, JLJ; Depre, C; Gerber, BL; Borgers, M; Wijns, W; Robert, A; Dion, R; Melin, JA;
Indirizzi:
Clin Univ St Luc, Div Cardiol, B-1200 Brussels, Belgium Clin Univ St Luc Brussels Belgium B-1200 rdiol, B-1200 Brussels, Belgium Clin Univ St Luc, Div Cardiovasc Surg, B-1200 Brussels, Belgium Clin Univ St Luc Brussels Belgium B-1200 Surg, B-1200 Brussels, Belgium Clin Univ St Luc, Div Nucl Med, B-1200 Brussels, Belgium Clin Univ St LucBrussels Belgium B-1200 l Med, B-1200 Brussels, Belgium Ctr Cardiovasc, Div Cardiol, Aalst, Belgium Ctr Cardiovasc Aalst Belgium tr Cardiovasc, Div Cardiol, Aalst, Belgium Janssen Res Fdn, B-2340 Beerse, Belgium Janssen Res Fdn Beerse Belgium B-2340 en Res Fdn, B-2340 Beerse, Belgium
Titolo Testata:
AMERICAN JOURNAL OF CARDIOLOGY
fascicolo: 12, volume: 85, anno: 2000,
pagine: 1432 - 1439
SICI:
0002-9149(20000615)85:12<1432:TCOFRA>2.0.ZU;2-N
Fonte:
ISI
Lingua:
ENG
Soggetto:
MYOCARDIAL BLOOD-FLOW; POSITRON EMISSION TOMOGRAPHY; HIBERNATING MYOCARDIUM; NONINVASIVE QUANTIFICATION; GLUCOSE-UTILIZATION; N-13 AMMONIA; WALL MOTION; REVASCULARIZATION; ECHOCARDIOGRAPHY; DOBUTAMINE;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
26
Recensione:
Indirizzi per estratti:
Indirizzo: Vanoverschelde, JLJ Clin Univ St Luc, Div Cardiol, Ave Hippoccrate 10 2881, B-1200 Brussels, Belgium Clin Univ St Luc Ave Hippoccrate 10 2881 Brussels Belgium B-1200
Citazione:
J.L.J. Vanoverschelde et al., "Time course of functional recovery after coronary artery bypass graft surgery in patients with chronic left ventricular ischemic dysfunction", AM J CARD, 85(12), 2000, pp. 1432-1439

Abstract

Chronic left ventricular (LV) ischemic dysfunction, a condition often referred to as myocardial hibernation, is associated in humans with ultrastructural alterations of the myocytes, including the loss of myofilaments and the accumulation of glycogen. Given the severity of these structural changes,contractile function is unlikely to resume immediately upon revascularization. Therefore, the aim of the present study was to assess the time course of functional improvement after successful revascularization as well as itspotential structural correlates. We studied 32 patients with coronary disease and chronic LV ischemic dysfunction who underwent bypass surgery. Dynamic positron emission tomagraphy with N-13 ammonia and F-18 deoxyglucose to assess myocardial perfusion and glucose metabolism was performed in 29 patients. In all patients, a transmural biopsy was harvested from the center ofthe dysfunctional area, to quantify the increase in extracellular matrix and the presence of structurally altered cardiomyocytes. LV function was serially measured by digitized 2-dimensional echocardiography before and at 10days, 2 months, and 6 months after revascularization. The time course of recovery of regional function was estimated from the monaexponential decrease in dysfunctional wall motion score. At follow-up, 19 patients had improved LV function, whereas 13 patients showed persistent dysfunction. Before revascularization, reversibly dysfunctional segments had higher myocardial blood flow (82 +/- 29 vs 53 +/- 21 ml . (min . 100 g)(-1), p = 0.044), higherglucose uptake (40 +/- 16 vs 21 +/- 9 mu mol (min . 100 g)(-1), p = 0.001), and less increase in extracellular matrix (25 +/- 15% vs 46 +/- 17%, p = 0.0008) than segments with persistent dysfunction. The extent to which function recovered was positively correlated with myocardial blood flow and negatively correlated with the increase in the extracellular matrix, In patients with reversible dysfunction, the return of segmental function was progressive and followed a monoexponential time course with a median time constant of 23 days (range 6 to 78). The rate of recovery correlated best with theproportion of altered cardiomyocytes in the biopsy. The present study thusindicates that the recovery of regional and global LV function after successful revascularization is progressive and follows a monoexponential time course that is influenced by the extent of the structural changes affecting cardiomyocytes. (C) 2000 by Excerpta Medica, Inc.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 22/01/20 alle ore 06:37:43