INFLUENCE OF COMPLETENESS HEART REVASCULARIZATION ON A FUNCTIONAL CONDITION OF MYOCARDIUM AT ISCHEMIC CARDIOMYOPATHY
https://doi.org/10.15825/1995-1191-2013-4-55-63
Abstract
The aim of this study was to define influence of completeness heart revascularization on a functional condition of myocardium at ischemic cardiomyopathy.
Materials and methods. 61 men and 5 women aged from 46 till 73 years with the diagnosis an ischemic cardiomyopathy were investigated before and after coronary angioplasty (EDV LV – 256,1 ± 7,4 ml, EF LV – 36,1 ± 1,1%). 46 patients had at receipt CHF with NYHA functional class 4, 20 – CHF with NYHA functional class 3. Functional status (6-minute walking test) – 109,7 ± 20,5 m. Chronic total occlusion was the major type of coronary artery disease (92 of 176 epicardial branches). By means of echocardiography and quantitative gated SPECT estimated dynamics of systolic and diastolic function, change of perfusion, thickening and myocardial movement.
Results. The full revascularization managed to be executed to 32 patients, incomplete – to 34 patients (34 occluded arteries didn't manage to be opened). In the whole group the 6-minute walking test incre- ased to 268,2 ± 19,9 m (p < 0,001), EF LV grew to 39,9±1,1% (p < 0,01) due to reduction of end systolic volume, degree of mitral regurgitation decreased from 1,6 ± 0,1 to 1,2 ± 0,1 (p < 0,007), pulmonary artery pressure decreased from 39,1 ± 1,7 to 32,1 ± 1,2 mm Hg (p < 0,01). Distinctions in dynamics of the main functional indicators between groups of complete and incomplete revascularization it isn't revealed. The factor of expressiveness of collateral blood flow in the region of occluded arteries probably compensates violation of an antegrade blood flow and defines a myocardial condition.
Conclusion. The volume of myocardial revascularization at patients with ischemic cardio- myopathy isn't defining factor in a clinical condition of them after executed percutaneous coronary intervention.
About the Authors
V. V. Chestukhin
Department of endovascular methods of treatment (Head – prof. V.V. Chestukhin) Academician
V.I. Schumakov Federal Research Center of Transplantology and Artificial Organs, Ministry of Health of the Russian Federation (Head – academician of RAMSci, prof. S.V. Gautier) Moscow, Russian Federation
A. B. Mironkov
Department of endovascular methods of treatment (Head – prof. V.V. Chestukhin) Academician
V.I. Schumakov Federal Research Center of Transplantology and Artificial Organs, Ministry of Health of the Russian Federation (Head – academician of RAMSci, prof. S.V. Gautier) Moscow, Russian Federation
Department of endovascular diagnostic and treatment (Head – cand. of med. sci. A.B. Mironkov) City clinical hospital No 12 of Department of healthcare of Moscow (Head – cand of med. sci. A.V. Salikov) Moscow, Russian Federation
F. A. Blyakhman
Medical Physics Chair (Head – prof. F.A. Blyakhman) of Ural State Medical University (rector – prof. S.M. Kutepov), Yekaterinburg, Russian Federation
General Physics Chair (Head – prof. V.G. Chernyak), Institute of Natural Science (Director – cand.
of phys.-mat. sci. V.V. Kruzhaev) of the Ural Federal University named after the first President of Russia B.N. Yeltsin, Yekaterinburg, Russian Federation
E. N. Ostroumov
Department of radionuclear diagnostic (Head – cand. of med. sci. A.E. Ermolenko) Academician
V.I. Schumakov Federal Research Center of Transplantology and Artificial Organs, Ministry of Health of the Russian Federation (Head – academician of RAMSci, prof. S.V. Gautier) Moscow, Russian Federation
S. G. Kolchanova
General Physics Chair (Head – prof. V.G. Chernyak), Institute of Natural Science (Director – cand.
of phys.-mat. sci. V.V. Kruzhaev) of the Ural Federal University named after the first President of Russia B.N. Yeltsin, Yekaterinburg, Russian Federation
T. F. Shklyar
Medical Physics Chair (Head – prof. F.A. Blyakhman) of Ural State Medical University (rector – prof. S.M. Kutepov), Yekaterinburg, Russian Federation
General Physics Chair (Head – prof. V.G. Chernyak), Institute of Natural Science (Director – cand.
of phys.-mat. sci. V.V. Kruzhaev) of the Ural Federal University named after the first President of Russia B.N. Yeltsin, Yekaterinburg, Russian Federation
E. T. Asoev
Department of endovascular methods of treatment (Head – prof. V.V. Chestukhin) Academician
V.I. Schumakov Federal Research Center of Transplantology and Artificial Organs, Ministry of Health of the Russian Federation (Head – academician of RAMSci, prof. S.V. Gautier) Moscow, Russian Federation
S. A. Sakhovsky
Department of endovascular methods of treatment (Head – prof. V.V. Chestukhin) Academician
V.I. Schumakov Federal Research Center of Transplantology and Artificial Organs, Ministry of Health of the Russian Federation (Head – academician of RAMSci, prof. S.V. Gautier) Moscow, Russian Federation
References
1. СПИСОК ЛИТЕРАТУРЫ
2. Guidelines on myocardial revascularization. European Journal of Cardio-thoracic Surgery. 2010; 38: 1–52.
3. Schinkel A.F., Bax J.J., Delgado V., Poldermans D., Ra-
4. himtoola S.H. Clinical relevance of hibernating myo- cardium in ischemic left ventricular dysfunction. Am. J. Med. 2010; Nov. 123 (11): 978–986.
5. Миронков А.Б., Покатилов А.А., Рядовой И.Г., Остроумов Е.Н., Честухин В.В. Коронарная ангиопластика у потенциальных реципиентов донорского сердца. Диагностическая и интервенционная радиология. 2007; 3: 66–76.
6. Kwon D.H., Hachamovitch R., Popovic Z.B. Survival in patients with severe ischemic cardiomyopathy undergo- ing revascularization versus medical therapy: associati- on with end-systolic volume and viability. Circulation. 2012; 126: 11 Suppl 1: 3–8.
7. Lorusso R., La Canna G., Ceconi C. Long-term results of coronary artery bypass grafting procedure in the pre- sence of left ventricular dysfunction and hibernating myocardium. Eur. J. Cardiothorac. Surg. 2001; 20: 937– 948.
8. Pagley P.R., Beller G.A., Watson D.D. Improved out- come after coronary bypass surgery in patients with ischemic cardiomyopathy and residual myocardial via- bility. Circulation. 1997; 96: 793–800.
9. Jones E.L., Weintraub W.S. The importance of complete- ness of revascularization during long-term follow-up after coronary artery operations. J. Thorac. Cardiovasc. Surg. 1996; 112: 227–237.
10. Ennker J., Bauer S., Ennker I.C. Revascularization sur- gery as a treatment concept for heart failure. HSR Proc. Intensive Care Cardiovasc. Anesth. 2013; 5 (2): 89–97.
11. Fox K., Garcia M.A. Guidelines on the management of stable angina pectoris: executive summary: the Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. Eur. Heart J. 2006; 27: 1341–1381.
12. Sianos G., Morel M.A., Kappetein A.P. et al. The SYN- TAX score: an angiographic tool grading the complexity of coronary artery disease. Eurointervention. 2005; 1:
13. –227.
14. Агеев Ф.Т., Овчинников А.Г. Давление наполнения левого желудочка: механизмы развития и ультразвуковая оценка. ЖСН. 2012; 5: 287–309.
Review
For citations:
Chestukhin V.V., Mironkov A.B., Blyakhman F.A., Ostroumov E.N., Kolchanova S.G., Shklyar T.F., Asoev E.T., Sakhovsky S.A. INFLUENCE OF COMPLETENESS HEART REVASCULARIZATION ON A FUNCTIONAL CONDITION OF MYOCARDIUM AT ISCHEMIC CARDIOMYOPATHY. Russian Journal of Transplantology and Artificial Organs. 2013;15(4):55-63. (In Russ.) https://doi.org/10.15825/1995-1191-2013-4-55-63
Views:
1272
Email this article 