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Abstract:

Aim: was to estimate parameters of left ventricle (LV) perfusion and kinetics at ischemic chronic heart failure (CHF), which initial values are predictors of increased myocardial functional reserve and patients clinical status improvement as a result of revascularization.

Materials and methods: examined 157 patients (146 men and 11 women; age from 33 to 72 years) before and in 2 - 3 days after percutaneous coronary intervention with diagnosis: CAD, CHF with NYHA class III-IV echocardiography parameters of LV: ejection fraction less than 40%, end-diastolic volume is more than 200 ml. Perfusion and function disorders were estimated with use of ECG-gated single photon emission computed tomography (SPECT).

Results: in 48% of cases 6-minute walk test increased more than 150%; NYHA class decreased by 2 classes (group 1). In 52% cases 6-minute walk test increased less than 50% and the NYHA class decreased on 1 class or did not change (group 2). Comparison of initial LV condition and clinical effect revealed following conformities. The revascularization effect is limited not to extent of coronary blood flow recovery, but first of all a cardiac muscle condition, the quantitative relation of the functioning myocardium and a focal cardiosclerosis. Thus, critical size to define the favorable forecast of revascularization is perfusion disorder more than a half of LV and kinetics disorder more than a third of cardiac muscle volume. Prevalence of a cardiosclerosis over the functioning myocardium limits clinical effect of a revascularization and growth of a functional reserve.

Conclusion: degree of initial LV myocardium perfusion and movement disorders at patients with severe ischemic heart failure is the key indicator, influencing clinical efficiency of coronary intervention

 

References

1.     Ageev F.T., Belenkov Yu.N., Fomin I.V., et al. Rasprostranennost hronicheskoj serdechnoj nedostatochnosti v Evropejskoj chaste Rossijskoj Federacii - dannye JEPOHA-HSN [The prevalence of chronic heart failure in the European part of the Russian Federation - Data AGE-CHF]. Serdechnaya nedostatochnost. 2006;7(1):112-115 [In Russ].

2.     Bax J.J., Delgado V. Myocardialviability as integral-part of the diagnostic and therapeutic approach to ischemic heart failure. J Nucl Cardiol. 2015 Apr;22(2): 229-45.

3.     Mareev V.Yu., Danielyan M.O., Belenkov Yu.N., Ot imeni rabochej gruppy issledovaniya JEPOHA-O-HSN. Sravnitelnaya harakteristika bolnyh s HSN v zavisimosti ot velichiny FV po rezultatam Rossijskogo mnogocentrovogo issledovaniya JEPOHA-O-HSN [On behalf of the working group study AGE-O-CHF. Comparative characteristics of patients with CHF, depending on the size of the PV on results of Russian studies mnogotsentrovogo AGE-O-CHF]. Serdechnaya nedostatochnost. 2006;7 (4):164-171 [In Russ].

4.     Samady H., Elefteriades J.A., Abbott B.G., et al. Failure to improve left ventricular function after coronary revascularization for ischemic cardiomyopathy is not associated with worse outcome. Circulation. 1999;100:1298- 304.

5.     Patel H.C., Ellis S.G.Role of revascularization to improveleft ventricular function. Heart Fail Clin. 2015 Apr; 11(2):203-14.

6.     Yancy C.W., Jessup M., Bozkurt B., et al. 2013 ACCF/AHA guideline for the management of heart failure: executive summary. J Am Coll Cardiol 2013;62:1495-539.

7.     McMurray J.J., Adamopoulos S., Anker S.D., et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012;33:1787-847.

8.     Fonseca C., Morais H., Mota T., Matias F., Costa C., Gouveia-Oliveira A., Ceia F. EPICA Investigators. The diagnosis of heart failure in primary care: value of symptoms and signs. Eur J Heart Fail. 2004 Oct; 6(6):795-800, 821-2.

9.     Shabana A., El-Menyar A. Myocardial viability: what we knew and what is new. Cardiol Res Pract. 2012; 2012:607486.

10.   Ling L.F., Marwick T.H., Flores D.R., Jaber W.A.. Brunken R.C., Cerqueira M.D., Hachamovitch R.Identification of therapeutic benefit from revascularization in patients with left ventricular systolic dysfunction: inducible ischemia versus hibernating myocardium. Circ Cardiovasc Imaging. 2013 May 1;6(3):363-72.

11.   Schinkel A.F., Poldermans D., Rizzello V., Vanoverschelde J.L., Elhendy A., Boersma E., Roelandt J.R., Bax J.J. Why do patients with ischemiccardiomyopathy and a substantialamount of viablemyocardium not always recover in function after revascularization? J Thorac Cardiovasc Surg. 2004 Feb;127(2):385-90.

12.   Mandegar M.H., Yousefnia M.A., Roshanali F., Rayatzadeh H., Alaeddini F. Interaction between two predictors of functional outcome after revascularization in ischemic cardiomyopathy: left ventricular volume and amount of viable myocardium. J Thorac Cardiovasc Surg. 2008 Oct; 136(4):930-6.

13.   Beanlands R.S.B., Dawood F., Wen W.H. et al. Are the kinetics of technetium 99m-methoxy isobutyl isonitrile affected by cell metabolism and viability? Circulation. 1990; 82:1802-1814.

14.   Rizzello V., Schinkel A.F., Bax J.J., et al. «Individual prediction of functional recovery after coronary revascularization in patients with ischemic cardiomyopathy: the scar-to-biphasic model» Am J Cardiol. 2003 Jun 15;91 (12): 1406-9.

15.   Chestuhin V.V., Mironkov A.B., Bljahman F.A., Ostroumov E.N., Kolchanova S.G., Shkljar T.F., Azoev Je.T., Sahovskij S.A. Vlijanie polnoty revaskuljarizacii serdca na funkcional'noe sostojanie miokarda pri ishemicheskoj kardiomiopatii [Influence of completeness of coronary revascularization on the functional state of the myocardium in ischemic cardiomyopathy.]. Vestnik transplantologii i iskusstvennyh organov. 2013: 14(4):55-63 [In Russ].

16.   Bax J.J., Visser F.C., Poldermans D., et al. Time course of functional recovery of stunned and hibernating segments after surgical revascularization. Circulation. 2001; 104(Suppl 1):I314 -8.

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