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[Ventricular function in patients with silent myocardial ischemia before and following aortocoronary bypass
1Rehabilitationszentrum für rheumatische Erkrankungen, Ludwig Boltzmann-Institut für Rehabilitation interner Erkrankungen, Saalfelden.
Insights
Coronary artery bypass surgery significantly improved exercise ejection fraction and diastolic function in patients with silent myocardial ischemia and coronary heart disease. This revascularization enhanced cardiac performance, benefiting both symptomatic and asymptomatic individuals.
Area of Science:
- Cardiology
- Cardiac Surgery
- Nuclear Cardiology
Context:
- Coronary heart disease (CHD) affects millions globally.
- Silent myocardial ischemia poses diagnostic challenges.
- Left ventricular ejection fraction (LVEF) and diastolic function are key cardiac health indicators.
Purpose:
- To evaluate the impact of coronary artery bypass surgery (CABS) on LVEF and diastolic function.
- To compare outcomes in patients with silent myocardial ischemia versus symptomatic CHD.
- To assess cardiac performance pre- and post-revascularization using Nuclear Stethoscope technology.
Summary:
- The study assessed 12 patients with silent ischemia and 15 with symptomatic CHD before and after CABS.
- While resting LVEF showed minor, insignificant improvement, exercise LVEF significantly increased in both groups (p < 0.0001).
- Diastolic function, measured by Peak Filling Rate (PFR) and Time to Peak Filling Rate (TPFR), also showed significant enhancement (p < 0.02).
Impact:
- CABS demonstrates significant benefits for improving cardiac function in CHD patients.
- Revascularization effectively restores contractile and diastolic reserve, crucial for long-term outcomes.
- Nuclear cardiology provides valuable insights into functional improvements post-surgery.
Abstract:
In 12 patients with silent myocardial ischemia (fall of the ejection fraction (EF) greater than or equal to 5%, without angina pectoris) and in 15 symptomatic patients with coronary heart disease (fall of the EF during exercise EF greater than or equal to 5%, with angina pectoris), the left ventricular ejection fraction and the diastolic function (Peak Filling Rate, PFR; Time to Peak Filling Rate, TPFR) were evaluated before coronary artery bypass surgery and afterwards by the aid of the Nuclear Stethoscope. Our results showed a slight insignificant improvement in the EF from 60 +/- 8.3 per cent at rest to 66 +/- 7.9 per cent vs. 57 +/- 12 per cent to 62.6 +/- 9 per cent in patients with silent ischemia and in patients with angina pectoris after surgery. In contrast to this the EF increased significantly during exercise both in patients with silent ischemia from 52.0 +/- 15.2 per cent to 70.1 +/- 7.9 per cent and in symptomatic patients after revascularisation from, 49 +/- 11.7 per cent on to 64.2 +/- 8.4 per cent (both p less than 0.0001). There was also a similar significant improvement in the diastolic function, whereby the PFR was enhanced from 2.52 +/- 0.54 EDV/sec to 3.31 +/- 0.87 EDV/sec (p less than 0.02) in patients with silent myocardial ischemia and from 2.55 +/- 0.86 EDV/sec to 3.40 +/- 0.98 EDV/sec (p less than 0.02) in symptomatic patients. The TPFR showed a similar improvement.