Relationship between myocardial viability and early application of intra-aortic balloon pump after coronary artery bypass grafting_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Lu ¹ , HU Yijin ¹ , LI Jianming ² , WANG Jiao ² ,  WANG Hongwu ¹

1. Department of Anesthesiology, TEDA International Cardiovascular Hospital, Tianjin University, Tianjin, 300457, P. R. China;
2. Department of Nuclear Medicine, TEDA International Cardiovascular Hospital, Tianjin University, Tianjin, 300457, P. R. China;

Corresponding?author：

WANG Hongwu, Email: wanghw1967@163.com

Keywords：

Coronary artery disease; coronary artery bypass grafting; myocardial viability by PET-CT; intra-aortic balloon pump

DOI：

10.7507/1007-4848.202106050

Video：

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Objective To explore the relationship between myocardial viability in patients with coronary artery disease who underwent elective coronary artery bypass grafting (CABG) and early application of intra-aortic balloon pump (IABP) after coronary revascularization, and to provide relevant clinical reference for the pre-implantation of 16G single-lumen catheter in the femoral artery of high-risk patients to facilitate the addition of IABP after operation.Methods This retrospective study included 521 patients (414 males and 107 females, aged 62.50±8.82 years) who underwent positron emission tomography (PET)-computed tomography (CT) perfusion-metabolism imaging prior to CABG surgery in our institution from December 2015 to August 2020. The myocardial viability information and left ventricular functional parameters were measured, including the proportion of non-viable myocardium (perfusion-metabolic imaging match), hibernating myocardium (perfusion-metabolic imaging mismatch) and dysfunctional myocardium (non-viable+viable myocardium), left ventricular ejection fraction, left ventricular end-diastolic volume and left ventricular end-systolic volume (LVESV). The patients were divided into an IABP group and a non-IABP group according to whether they received IABP treatment after revascularization. The clinical data were reviewed and compared to explore significant impact factors between the two groups. And the multivariate logistic regression analysis was performed to investigate the correlation between preoperative myocardial viability and early use of IABP after CABG.Results In multivariate logistic regression analysis, the amount of non-viable, dysfunctional myocardium and LVESV value were identified as the independent predictors for the probability of IABP use in the initial postoperative period. Receiver operating characteristic analysis showed that 9.5% non-viable myocardium, 19.5% dysfunctional myocardium, and LVESV of 114.5 mL were the optimal cutoff for predicting early IABP implantation during CABG.Conclusion The myocardial survival status displayed by preoperative PET-CT myocardial perfusion-metabolism imaging can predict the possibility of applying IABP in CABG perioperative period. In addition to routine pre-anesthesia assessment, anesthesiologists can conduct risk stratification assessment for patients with CABG according to the results of preoperative myocardial viability imaging, which is of great significance to ensure the perioperative safety of high-risk patients with CABG.

Citation： ZHANG Lu, HU Yijin, LI Jianming, WANG Jiao, WANG Hongwu. Relationship between myocardial viability and early application of intra-aortic balloon pump after coronary artery bypass grafting. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(3): 396-402. doi: 10.7507/1007-4848.202106050 Copy

1.	Zhang F, Wang J, Shao X, et al. Incremental value of myocardial wall motion and thickening to perfusion alone by gated SPECT myocardial perfusion imaging for viability assessment in patients with ischemic heart failure. J Nucl Cardiol, 2021, 28(6): 2545-2556.
2.	Malhotra S, Gomez J, Doukky R. Assessment of myocardial viability using single-photon emission computed tomography myocardial perfusion imaging. Curr Opin Cardiol, 2019, 34(5): 473-483.
3.	吳清玉, 許建屏, 高長青, 等. 冠狀動脈旁路移植術技術指南. 中華外科雜志, 2006, 44(22): 1517-1524.
4.	孫笑天, 龐烈文. 冠狀動脈旁路移植術的現況與展望. 上海醫藥, 2012, 33(2): 11-14, 20.
5.	Dilsizian V, Bacharach SL, Beanlands RS, et al. ASNC imaging guidelines/SNMMI procedure standard for positron emission tomography (PET) nuclear cardiology procedures. J Nucl Cardiol, 2016, 23(5): 1187-1226.
6.	孫茉茉, 李劍明, 劉志剛. 冠狀動脈旁路移植術前13N-NH3/18F-FDG PET顯像測冬眠心肌的臨床研究. 中國醫學影像技術, 2018, 34(7): 1003-1008.
7.	付春華. 主動脈內球囊反搏泵的臨床應用進展. 心血管病學進展, 2014, 35(2): 265-268.
8.	吳冬冬, 劉志剛, 李劍明, 等. 心肌活力預測缺血性心力衰竭患者冠狀動脈旁路移植術后心功能改善的臨床研究. 中國胸心血管外科臨床雜志, 2020, 27(11): 1314-1319.
9.	楊彥松, 張曉膺, 王躍濤, 等. 存活心肌數量預測冠狀動脈旁路移植術后左心室射血分數改善. 中華胸心血管外科雜志, 2016, 32(5): 279-282.
10.	中華醫學會心血管病學分會影像學組, 中國醫師協會放射醫師分會心血管專業委員會. 無創性心血管影像學技術臨床適用標準中國專家共識. 中華心血管病雜志, 2020, 48(11): 906-921.
11.	孫茉茉, 李劍明, 劉志剛. PET/CT檢測冠狀動脈旁路移植術患者存活心肌的研究進展. 醫學綜述, 2017, 23(16): 3291-3295, 3301.
12.	中華醫學會核醫學分會中華醫學會心血管病學分會. 核素心肌顯像臨床應用指南 (2018). 中華心血管病雜志, 2019, 47(7): 519-527.
13.	Khalaf S, Chamsi-Pasha M, Al-Mallah MH. Assessment of myocardial viability by PET. Curr Opin Cardiol, 2019, 34(5): 466-472.
14.	Madsen S, Dias AH, Lauritsen KM, et al. Myocardial viability testing by positron emission tomography: Basic concepts, mini-review of the literature and experience from a tertiary PET center. Semin Nucl Med, 2020, 50(3): 248-259.
15.	Kerkhof PLM, van de Ven PM, Yoo B, et al. Ejection fraction as related to basic components in the left and right ventricular volume domains. Int J Cardiol, 2018, 255: 105-110.
16.	Huttin O, Mandry D, Eschalier R, et al. Cardiac remodeling following reperfused acute myocardial infarction is linked to the concomitant evolution of vascular function as assessed by cardiovascular magnetic resonance. J Cardiovasc Magn Reson, 2017, 19(1): 2.
17.	Bolognese L, Neskovic AN, Parodi G, et al. Left ventricular remodeling after primary coronary angioplasty: Patterns of left ventricular dilation and long-term prognostic implications. Circulation, 2002, 106(18): 2351-2357.
18.	Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart disease and stroke statistics-2017 update: A report from the American Heart Association. Circulation, 2017, 135(10): e146-e603.
19.	Boden WE, Brooks WW, Conrad CH, et al. Incomplete, delayed functional recovery late after reperfusion following acute myocardial infarction: "Maimed myocardium". Am Heart J, 1995, 130(4): 922-932.
20.	Ramos M, DePasquale E, Coplan NL. Assessment of myocardial viability: Review of the clinical significance. Rev Cardiovasc Med, Fall 2008, 9(4): 225-231.
21.	Parissis H, Soo A, Al-Alao B. Intra-aortic balloon pump (IABP): From the old trends and studies to the current "extended" indications of its use. J Cardiothorac Surg, 2012, 7: 128.
22.	He XY, Gao CQ. Peri-operative application of intra-aortic balloon pumping reduced in-hospital mortality of patients with coronary artery disease and left ventricular dysfunction. Chin Med J (Engl), 2019, 132(8): 935-942.
23.	Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: A report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation, 2011, 124(23): e652-e735.
24.	何瀟一, 王嶸, 高長青, 等. 冠狀動脈粥樣硬化性心臟病伴輕度左心功能不全患者圍術期應用主動脈內球囊反搏早中期結果分析. 中國體外循環雜志, 2018, 16(1): 16-20, 11.
25.	Lehtinen M, Schildt J, Ahonen A, et al. Combining FDG-PET and 99mTc-SPECT to predict functional outcome after coronary artery bypass surgery. Eur Heart J Cardiovasc Imaging, 2015, 16(9): 1023-1030.
26.	Ali US, Lan NSR, Gilfillan M, et al. Preoperative intra-aortic balloon pumps in cardiac surgery: A propensity score analysis. Heart Lung Circ, 2021, 30(5): 758-764.
27.	Gunnarsdóttir SLX, Gunnarsdóttir ELT, Heimisdottir AA, et al. The use of intra aortic balloon pump in coronary artery bypass graft surgery. Laeknabladid, 2020, 106(2): 63-70.
28.	Jannati M, Attar A. Intra-aortic balloon pump postcardiac surgery: A literature review. J Res Med Sci, 2019, 24: 6.
29.	姜睿, 胡盛壽, 田月琴, 等. 局部心肌存活狀態與冠狀動脈旁路移植術后遠期心血管事件的關系. 中國循環雜志, 2009, 24(1): 24-27.

1. Zhang F, Wang J, Shao X, et al. Incremental value of myocardial wall motion and thickening to perfusion alone by gated SPECT myocardial perfusion imaging for viability assessment in patients with ischemic heart failure. J Nucl Cardiol, 2021, 28(6): 2545-2556.
2. Malhotra S, Gomez J, Doukky R. Assessment of myocardial viability using single-photon emission computed tomography myocardial perfusion imaging. Curr Opin Cardiol, 2019, 34(5): 473-483.
3. 吳清玉, 許建屏, 高長青, 等. 冠狀動脈旁路移植術技術指南. 中華外科雜志, 2006, 44(22): 1517-1524.
4. 孫笑天, 龐烈文. 冠狀動脈旁路移植術的現況與展望. 上海醫藥, 2012, 33(2): 11-14, 20.
5. Dilsizian V, Bacharach SL, Beanlands RS, et al. ASNC imaging guidelines/SNMMI procedure standard for positron emission tomography (PET) nuclear cardiology procedures. J Nucl Cardiol, 2016, 23(5): 1187-1226.
6. 孫茉茉, 李劍明, 劉志剛. 冠狀動脈旁路移植術前13N-NH3/18F-FDG PET顯像測冬眠心肌的臨床研究. 中國醫學影像技術, 2018, 34(7): 1003-1008.
7. 付春華. 主動脈內球囊反搏泵的臨床應用進展. 心血管病學進展, 2014, 35(2): 265-268.
8. 吳冬冬, 劉志剛, 李劍明, 等. 心肌活力預測缺血性心力衰竭患者冠狀動脈旁路移植術后心功能改善的臨床研究. 中國胸心血管外科臨床雜志, 2020, 27(11): 1314-1319.
9. 楊彥松, 張曉膺, 王躍濤, 等. 存活心肌數量預測冠狀動脈旁路移植術后左心室射血分數改善. 中華胸心血管外科雜志, 2016, 32(5): 279-282.
10. 中華醫學會心血管病學分會影像學組, 中國醫師協會放射醫師分會心血管專業委員會. 無創性心血管影像學技術臨床適用標準中國專家共識. 中華心血管病雜志, 2020, 48(11): 906-921.
11. 孫茉茉, 李劍明, 劉志剛. PET/CT檢測冠狀動脈旁路移植術患者存活心肌的研究進展. 醫學綜述, 2017, 23(16): 3291-3295, 3301.
12. 中華醫學會核醫學分會中華醫學會心血管病學分會. 核素心肌顯像臨床應用指南 (2018). 中華心血管病雜志, 2019, 47(7): 519-527.
13. Khalaf S, Chamsi-Pasha M, Al-Mallah MH. Assessment of myocardial viability by PET. Curr Opin Cardiol, 2019, 34(5): 466-472.
14. Madsen S, Dias AH, Lauritsen KM, et al. Myocardial viability testing by positron emission tomography: Basic concepts, mini-review of the literature and experience from a tertiary PET center. Semin Nucl Med, 2020, 50(3): 248-259.
15. Kerkhof PLM, van de Ven PM, Yoo B, et al. Ejection fraction as related to basic components in the left and right ventricular volume domains. Int J Cardiol, 2018, 255: 105-110.
16. Huttin O, Mandry D, Eschalier R, et al. Cardiac remodeling following reperfused acute myocardial infarction is linked to the concomitant evolution of vascular function as assessed by cardiovascular magnetic resonance. J Cardiovasc Magn Reson, 2017, 19(1): 2.
17. Bolognese L, Neskovic AN, Parodi G, et al. Left ventricular remodeling after primary coronary angioplasty: Patterns of left ventricular dilation and long-term prognostic implications. Circulation, 2002, 106(18): 2351-2357.
18. Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart disease and stroke statistics-2017 update: A report from the American Heart Association. Circulation, 2017, 135(10): e146-e603.
19. Boden WE, Brooks WW, Conrad CH, et al. Incomplete, delayed functional recovery late after reperfusion following acute myocardial infarction: "Maimed myocardium". Am Heart J, 1995, 130(4): 922-932.
20. Ramos M, DePasquale E, Coplan NL. Assessment of myocardial viability: Review of the clinical significance. Rev Cardiovasc Med, Fall 2008, 9(4): 225-231.
21. Parissis H, Soo A, Al-Alao B. Intra-aortic balloon pump (IABP): From the old trends and studies to the current "extended" indications of its use. J Cardiothorac Surg, 2012, 7: 128.
22. He XY, Gao CQ. Peri-operative application of intra-aortic balloon pumping reduced in-hospital mortality of patients with coronary artery disease and left ventricular dysfunction. Chin Med J (Engl), 2019, 132(8): 935-942.
23. Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: A report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation, 2011, 124(23): e652-e735.
24. 何瀟一, 王嶸, 高長青, 等. 冠狀動脈粥樣硬化性心臟病伴輕度左心功能不全患者圍術期應用主動脈內球囊反搏早中期結果分析. 中國體外循環雜志, 2018, 16(1): 16-20, 11.
25. Lehtinen M, Schildt J, Ahonen A, et al. Combining FDG-PET and 99mTc-SPECT to predict functional outcome after coronary artery bypass surgery. Eur Heart J Cardiovasc Imaging, 2015, 16(9): 1023-1030.
26. Ali US, Lan NSR, Gilfillan M, et al. Preoperative intra-aortic balloon pumps in cardiac surgery: A propensity score analysis. Heart Lung Circ, 2021, 30(5): 758-764.
27. Gunnarsdóttir SLX, Gunnarsdóttir ELT, Heimisdottir AA, et al. The use of intra aortic balloon pump in coronary artery bypass graft surgery. Laeknabladid, 2020, 106(2): 63-70.
28. Jannati M, Attar A. Intra-aortic balloon pump postcardiac surgery: A literature review. J Res Med Sci, 2019, 24: 6.
29. 姜睿, 胡盛壽, 田月琴, 等. 局部心肌存活狀態與冠狀動脈旁路移植術后遠期心血管事件的關系. 中國循環雜志, 2009, 24(1): 24-27.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Relationship between myocardial viability and early application of intra-aortic balloon pump after coronary artery bypass grafting

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