초록접수 현황
| 14F-268 | 구연 발표 |
좌심실부전을 동반한 관상동맥질환자에서 관상동맥우회술 후의 좌심실기능 호전 및 임상결과 예측을 위한 심장자기공명영상 데이터의 유용성
황호영¹, 오홍철¹, 김용한¹, 오세진², 김기봉¹
서울대학교 의과대학 서울대학교병원 흉부외과학교실¹, 서울대학교 보라매병원 흉부외과²
목적 : We examined cardiac magnetic resonance (CMR) variables to predict left ventricular function improvement and evaluated clinical outcomes after coronary artery bypass grafting (CABG) in patients with left ventricular dysfunction.
방법 : Seventy patients with decreased left ventricular ejection fraction (LVEF ≤35%) who underwent primary isolated CABG and had preoperative CMR were enrolled. Of those, LVEF measured using transthoracic echocardiography was followed serially in 62 patients; preoperatively, before discharge, and during the first-year follow-up. Predictors of absolute increase (≥5%) and proportional changes in LVEF were analyzed. Viable myocardial segment was defined as transmural extent of late gadolinium enhancement <50%.
결과 : Sixty-nine patients underwent off-pump CABG and intraoperative conversion was needed in one. In 16-segments model, median number of viable myocardial segments was 12 (ranges;6-16). In-hospital mortality occurred in 2 patients. Mean LVEF at preoperative, early postoperative and follow-up periods were 28.6±5.4%, 31.5±8.0%, and 42.1±10.5%, respectively. LVEF improvement (absolute increase ≥5%) was found early after surgery in 28 and during the follow-up in another 19 patients. One-and 4-year survival rates were 88% and 80%, respectively. One-and 4-year major adverse cardiac and cerebrovascular event-free rates were 84% and 79%, respectively. Multivariable models demonstrated that median number of viable myocardial segments ≥12 was associated with absolute increase (relative risk=0.102, p=0.008) and proportional changes (p=0.008) in LVEF. However, Cox proportional hazard model failed to demonstrate significant factors associated clinical outcomes.
결론 : Number of viable myocardial segments evaluated with CMR predicted LVEF improvement after CABG in patients with left ventricular dysfunction. Further study needed to identify parameters associated with long-term clinical outcomes.
방법 : Seventy patients with decreased left ventricular ejection fraction (LVEF ≤35%) who underwent primary isolated CABG and had preoperative CMR were enrolled. Of those, LVEF measured using transthoracic echocardiography was followed serially in 62 patients; preoperatively, before discharge, and during the first-year follow-up. Predictors of absolute increase (≥5%) and proportional changes in LVEF were analyzed. Viable myocardial segment was defined as transmural extent of late gadolinium enhancement <50%.
결과 : Sixty-nine patients underwent off-pump CABG and intraoperative conversion was needed in one. In 16-segments model, median number of viable myocardial segments was 12 (ranges;6-16). In-hospital mortality occurred in 2 patients. Mean LVEF at preoperative, early postoperative and follow-up periods were 28.6±5.4%, 31.5±8.0%, and 42.1±10.5%, respectively. LVEF improvement (absolute increase ≥5%) was found early after surgery in 28 and during the follow-up in another 19 patients. One-and 4-year survival rates were 88% and 80%, respectively. One-and 4-year major adverse cardiac and cerebrovascular event-free rates were 84% and 79%, respectively. Multivariable models demonstrated that median number of viable myocardial segments ≥12 was associated with absolute increase (relative risk=0.102, p=0.008) and proportional changes (p=0.008) in LVEF. However, Cox proportional hazard model failed to demonstrate significant factors associated clinical outcomes.
결론 : Number of viable myocardial segments evaluated with CMR predicted LVEF improvement after CABG in patients with left ventricular dysfunction. Further study needed to identify parameters associated with long-term clinical outcomes.
책임저자: 김기봉
서울대학교 의과대학 서울대학교병원 흉부외과학교실
연락처 : 황호영, Tel: 02-2072-3897 , E-mail : scalpel@hanmail.net
