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Published on: May 28, 2019
Effect of patent complete revascularization on the akinetic myocardial segments
Min-Seok Kim1,2, Min-Jeong Kim1, Hyeon Ju Jeong1
1Cardiovascular Center, Myongji Hospital, Gyeonggido, Republic of Korea.
Insights
Coronary artery bypass grafting improves left ventricular ejection fraction and regional wall motion over 12 months. Even akinetic myocardial segments show significant recovery after complete revascularization.
Area of Science:
- Cardiology
- Cardiac Surgery
- Echocardiography
Background:
- Coronary artery bypass grafting (CABG) is a common procedure for treating coronary artery disease.
- Assessing the functional recovery of the myocardium after CABG is crucial for patient outcomes.
Purpose of the Study:
- To evaluate changes in echocardiographic parameters following CABG.
- To compare the functional recovery of akinetic myocardial segments versus non-akinetic segments post-CABG.
Main Methods:
- 101 patients undergoing complete revascularization were followed with echocardiography at multiple time points (preoperative to 12 months postoperative).
- A 16-segment model was used for regional left ventricular analysis, categorizing segments by wall motion (normal, hypokinesia, akinesia with/without thinning).
Main Results:
- Left ventricular ejection fraction significantly increased from 0.48 preoperatively to 0.54 at 12 months post-CABG (P < 0.001).
- Wall motion scores improved in both akinetic and non-akinetic segments over time (P < 0.001).
- Improvement was significantly greater in segments that were akinetic preoperatively compared to those without akinesia (P < 0.001).
Conclusions:
- Significant improvements in left ventricular ejection fraction and regional wall motion are observed up to 12 months after CABG.
- Myocardial segments with preoperative akinesia demonstrate substantial recovery, suggesting the benefit of complete revascularization even in severely dysfunctional areas.
Objectives:
The aims of the study were (i) to examine the changes in echocardiographic parameters and (ii) to compare the fate of myocardial segments with akinesia and without akinesia on preoperative echocardiography after coronary artery bypass grafting.
Methods:
One hundred one patients who underwent complete revascularization, who were assessed by preoperative, before discharge, postoperative 3- and 12-month echocardiographic examinations, and who showed all patent grafts at postoperative 1-year angiograms were included. Echocardiographic left ventricular ejection fraction was assessed, and a 16-segment model was adopted for regional analysis of the left ventricle. A total of 1616 segments were analysed based on a 6-point scale: 1 = normal (N = 1083), 2 = mild hypokinesia (N = 2), 3 = moderate hypokinesia (N = 74), 4 = severe hypokinesia (N = 150), 5 = akinesia without thinning (N = 259) and 6 = akinesia with thinning (N = 48).
Results:
The serial left ventricular ejection fraction measured preoperatively, before discharge, at postoperative 3- and 12-months were 0.48 ± 0.14, 0.49 ± 0.12, 0.49 ± 0.10 and 0.54 ± 0.10, respectively. The left ventricular ejection fraction significantly increased over time during the postoperative 12 months (P < 0.001). Wall motion scores tended to decrease over time in both segment groups with akinesia and without akinesia (P < 0.001), and improvement of the wall motion was significantly higher in the segment group with akinesia than in the segment group without akinesia (P < 0.001).
Conclusions:
The left ventricular ejection fraction and regional wall motion improved over time during the postoperative 12 months, regardless of the presence of an akinetic segment. Complete revascularization including akinetic myocardium should be considered when performing coronary artery bypass grafting.
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