Value of preoperative proportion of hibernating myocardium to the prediction of left heart function improvement after off-pump coronary artery bypass grafting in patients with coronary heart disease and severe left ventricular dysfunction
Objective To observe the preoperative proportion of hibernating myocardium in left ventricular myocardium in patients with coronary heart disease complicated with severe left ventricular dysfunction,and to explore its value to the prediction of left heart function improvement after off-pump coronary artery bypass grafting(OPCAB).Methods From June 2020 to June 2022,46 patients with coronary heart disease complicated with severe left ventricular dysfunction received OPCAB in the First Affiliated Hospital of Zhengzhou University.The left ventricular ejection fraction(LVEF)and left ventricular end-diastolic volume(LVEDV)were compared before and 3 months after OPCAB.The LVEF 3 months after OPCAB was improved ≥ 5％in 34 patients(improvement group)and＜5％in 12 patients(non-improvement group),and the clinical data such as the preoperative proportion of hibernating myocardium and the ratio of atrial fibrillation were compared between two groups.Multivariate logistic regression analysis was used to assess the influencing factors of left heart function improvement after OPCAB in patients with coronary heart disease and severe left ventricular dysfunction.The ROC curves were plotted to evaluate the efficiency of preoperative proportion of hibernating myocardium on improving left heart function after OPCAB.Results In 46 patients,the LVEF was significantly higher 3 months after OPCAB[(37.7±5.6)％]than that before OPCAB[(28.7±3.9)％](t=-8.991,P=0.023),and the LVEDV showed no significant difference 3 months after OPCAB[(177.0±13.7)mL]compared with that before OPCAB[(192.6±12.4)mL](t=5.737,P=0.814).The proportion of hibernating myocardium before OPCAB was higher in improvement group[(18.9±4.0)％]than that in non-improvement group[(12.1±3.4)％](x2=5.640,P＜0.001),and the ratio of atrial fibrillation was lower in improvement group(11.8％)than that in non-improvement group(66.7％)(x2=-5.737,P＜0.001).The preoperative proportion of hibernating myocardium was an influencing factor of left heart function improvement after OPCAB(OR=2.449,95％CI:1.299-4.617,P=0.006).When the optimal cut-off value of preoperative proportion of hibernating myocardium was ≥16.5％,the AUC for predicting left heart function improvement after OPCAB was 0.911(95％CI:0.819-1.000,P＜0.001),the sensitivity was 73.5％,and the specificity was 91.7％.Conclusion High preoperative proportion of hibernating myocardium and no atrial fibrillation increase the probability of left heart function improvement after OPCAB in patients with coronary heart disease complicated with severe left ventricular dysfunction,and the preoperative proportion of hibernating myocardium has a high predictive value for the improvement of left heart function after OPCAB.
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