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Effect of myocardial revascularization on cardiac structural and functional capacity and myocardial desynchronization in chronic heart failure

Pribilova N. N., Osipova O. A., Vlasenko M. A., Vlasenko O. A., Godlevskaya O. M.

Keywords: coronary artery bypass, cardiac dyssynchrony, mammary-coronary bypass, structural and functional status

DOI: 10.18087/rhfj.2011.3.1418

Background. Myocardial revascularization may be one of the most effective methods of myocardial contractility recovery by influen­cing the basic pathogenic mechanisms of CHF. Objective. To study the role of cardiac dyssynchrony (CD) for impairment of myocardial propulsive capacity and influence of coronary artery bypass (CAB) and mammary-coronary bypass (MCB) on its hemodynamic capacity. Materials and methods. The study included 67 patients with stenosing coronary atherosclerosis (mean age 64.2±2 years) underwent CAB and MCB. Structural and functional properties, and regional myocardial contractility were studied by echocardiography and ECG. Results. CD as a broadened QRS complex was detected in 14.9 % of patients, presystolic mitral regurgitation – in 62.7 %, interventricular mechanical delay – in 73.1 %, delay in activation of posterolateral wall – in 68.6 % and delay of expulsion from aorta – in 68.6 %. MCB led to improvement of myocardial contractility, reduction of systolic and diastolic blood pressure, reduced end-systolic and end-diastolic volume (EDS and EDV) by 8.8 and 10.9 % respectively (p<0.01) and increased EF by 8 9 % (p<0.05). CAB in conjunction with MCB increased EDS and EDV (7.2 and 4.7 % respectively) and EF by 1 %. Positive structural and functional changes were accompanied by decrease of frequency of myocardial dyssynchrony: presystolic mitral regurgitation to 46.3 %, interventricular mechanical delay up to 56.7 %, posterolateral wall delay activation to 53.7 % and delay of expulsion from aorta to 52.2 %. Thus, CD is an important pathogenetic mechanism of reduction of cardiac hemodynamic capacity. Coronary revascularization (EDS and EDV) improves cardiac contractility and reduces the incidence of LV dyssynchrony.
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Pribilova N. N., Osipova O. A., Vlasenko M. A. et al. Effect of myocardial revascularization on cardiac structural and functional capacity and myocardial desynchronization in chronic heart failure. Russian Heart Failure Journal.2011;12(3):154-158

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