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J Thorac Cardiovasc Surg 1997;113:371-378
© 1997 Mosby, Inc.

CARDIOPULMONARY BYPASS, MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES

CORRELATION OF FUNCTIONAL RECOVERY WITH MYOCARDIAL BLOOD FLOW, GLUCOSE UPTAKE, AND MORPHOLOGIC FEATURES IN PATIENTS WITH CHRONIC LEFT VENTRICULAR ISCHEMIC DYSFUNCTION UNDERGOING CORONARY ARTERY BYPASS GRAFTING

Supported by grant 3-4522-89 from the "Fonds National de la Recherche Scientifique et Médicale" and by the "Action de Recherche Concertée" 91/96-146.

Received for publication May 6, 1996 revisions requested August 6, 1996; revisions received Sept. 4, 1996 accepted for publication Sept. 9, 1996. Address for reprints: Christophe Depré, MD, PhD, Division of Cardiology, University of Louvain Medical School, Avenue Hippocrate, 10-2881, B-1200 Brussels, Belgium.

Abstract

Objective: Our objective was to investigate the influence of preoperative myocardial ultrastructure and metabolism on recovery of contractile function after coronary artery bypass grafting in patients with coronary artery disease and left ventricular dysfunction. Methods: Dynamic positron emission tomography with ¹³N-ammonia and ¹⁸F-deoxyglucose was used to assess myocardial perfusion and glucose uptake in 53 patients scheduled for coronary revascularization because of coronary artery disease and left ventricular dysfunction. The degree of tissue fibrosis and the presence of potentially reversible alterations of cardiomyocytes (loss of myofilaments and accumulation of glycogen) were quantified from transmural biopsy specimens. These were harvested from the center of the dysfunctional area during the operation and analyzed with a light microscope. The recovery of contractile performance was assessed from the changes in left ventricular function at contrast ventriculography or echocardiography before and 6 months after the operation. Results: According to postoperative changes in regional wall motion, left ventricular function was considered to have improved in 34 patients, whereas dysfunction persisted in 19 patients. In patients with improved wall motion, ejection fraction rose by 12% and end-systolic volume decreased by 28%. By contrast, in patients with persistent dysfunction, ejection fraction decreased by 6% and end-systolic volume increased by 25%. Before revascularization, myocardium with reversible dysfunction displayed higher levels of absolute myocardial blood flow, higher myocardial glucose uptake, less tissue fibrosis, and more altered cardiomyocytes than myocardium with persistent dysfunction. Significant correlations were found between regional blood flow and the surface of the biopsy specimen covered by fibrosis, as well as between glucose uptake and the density of altered cardiomyocytes. Conclusion: In patients with left ventricular ischemic dysfunction, the recovery of regional and global left ventricular function after surgical revascularization is associated with higher preoperative blood flow and glucose uptake, with less tissue fibrosis and a higher amount of viable cardiomyocytes in the dysfunctional area. The current study thus confirms the value of noninvasive preoperative metabolic imaging for identification of residual viable myocardium and for prediction of the functional outcome after revascularization.

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