Preoperative Quantitative Evaluation Of Viable Myocardium For Predicting Prognosis Of Coronary Artery Bypass Grafting In Patients With Ischemic Heart Failure

Objective:This study was designed to explore the prognostic effect of the quantity of viable myocardium on predicting coronary artery bypass grafting in patients with ischemic heart failure,in order to provide guidance for clinical treatment decisions for ischemic heart failureMethods:This study was a retrospective study of 13N-ammonia/18F-FDG PET/CT myocardial nucleus examination and ioslated coronary artery bypass grafting from December 08,2015 to November 12,2018 at the TEDA International Cardiovascular Hospital.Baseline data such as cardiogram(UCG),myocardial perfusion/metabolism PET/CT imaging,follow-up information,and cardiac ultrasound from March to June after surgery.All patients were rigorously screened according to the standard,and all were planned to be scheduled for midline open chest simple CABG.After 3-6,we reviewed UCG in our hospital.The left ventricular ejection fraction(LVEF)increased greater than 5%was recognized improved.LVEF value increased<5%divided into LVEF value non-improved group.The LVEF value was not improved,and the left ventricular end-diastolic diameter was(LVDd)reduction of ≥ 5%is considered to be LVDd reduced,and LVDd decrease of<5%is considered to be LVDd not reduced.Analyze the difference between the baseline indicators of the improved group and the non-improved group,the reduced group and the non-reduced group.Logistic multivariate analysis was used to analyze the correlation between viable myocardium and LVEF improvement Using ROC curve to find the boundary value of LVEF improved and LVEF non-improved.The logistic multivariate analysis was used to analyze the correlation between viable myocardium and LVDd reduction.ROC curve was used to determine LVDd.Decrease the threshold value that is not reduced with LVDd.Results:In 46 patients with ischemic heart failure who underwent CABG surgery for 3-6 months,32 patients had improved LVEF and 14 patients had no improvement in LVEF.The quantity of viable myocardium in the improved group was higher than that in the non-improved group(improved group 15.03±12.30,non-improved group 4.29 ±4.51,P<0.05).The quantity of normal myocardium in the improved group was lower than that in the non-improved group(improved group 74.72±13.72,non-improved group 82.43)±8.64,P<0.05),the improvement of NYHA classification in the improved group was higher than that in the non-improved group(improved group-0.72±0.73,non-improved group-0.29±0.47,P<0.05).Statistical differences;multivariate logistic analysis found that the number of viable myocardium was an independent factor in the improvement of LVEF after CABG in ischemic heart failure(OR=0.864,P<0.05);ROC curve showed LVEF improvement group and LVEF unimproved group The viable myocardium threshold was 15,the area under the curve was 0.765,the 95%confidence interval was 0.625-0.904,the sensitivity was 0.438,and the specificity was 1Conclusion:The quantity of viable myocardium is an independent impact factor for the improvement of LVEF after CABG in patients with ischemic heart failure.The percentage of viable myocardium to the left ventricle greater than 15%can accurately predict the improvement of LVEF after CABG in patients with ischemic heart failure.The percentage of viable myocardium to the left ventricle is less than 15%.CABG may not be recommended because the ischemic heart failure may be Can not benefit from revascularization.