Цель исследования

medvis

Медицинская визуализация

Medical Visualization

1607-07632408-9516

RDS-Media Ltd.

10.24835/1607-0763-1241

medvis-1241

Research Article

СЕРДЦЕ И СОСУДЫ

HEART AND VESSELS

Взаимосвязь дооперационных показателей перфузионной сцинтиграфии миокарда и флоуметрии маммарокоронарных шунтов у больных с ишемической кардиомиопатией

The preoperative myocardial perfusion and internal mammary artery graft blood flow relationship in patients with ischemic cardiomyopathy

https://orcid.org/0000-0001-9887-8214

Шипулин

В. В.

Shipulin

V. V.

Шипулин Владимир Владимирович – канд. мед. наук, научный сотрудник лаборатории радионуклидных методов исследования

634012 Томск, ул. Киевская, 111-А

Vladimir V. Shipulin – Cand. of Sci. (Med.), research associate, department of nuclear medicine

111-А, Kievskaya str., Tomsk 634012

shipartphoto@gmail.com

https://orcid.org/0000-0003-4402-0516

Гутор

С. С.

Gutor

S. S.

Гутор Сергей Сергеевич – канд. мед. наук, научный сотрудник лаборатории радионуклидных методов исследования

634012 Томск, ул. Киевская, 111-А

Sergey S. Gutor – Cand. of Sci. (Med.), research associate, department of nuclear medicine

111-А, Kievskaya str., Tomsk 634012

ssgutor@gmail.com

https://orcid.org/0000-0003-4049-8715

Андреев

С. Л.

Andreev

S. L.

Андреев Сергей Леонидович – канд. мед. наук, старший научный сотрудник отделения сердечно-сосудистой хирургии

634012 Томск, ул. Киевская, 111-А

Sergey L. Andreev – Cand. of Sci. (Med.), senior researcher, department of cardiothoracic surgery

111-А, Kievskaya str., Tomsk 634012

anselen@rambler.ru

https://orcid.org/0000-0003-0883-466X

Мочула

А. В.

Mochula

A. V.

Мочула Андрей Викторович – канд. мед. наук, старший научный сотрудник лаборатории радионуклидных методов исследования

634012 Томск, ул. Киевская, 111-А

Andrey V. Mochula – Cand. of Sci. (Med.), senior researcher, department of nuclear medicine

111-А, Kievskaya str., Tomsk 634012

https://orcid.org/0000-0003-3952-9983

Затолокин

В. В.

Zatolokin

V. V.

Затолокин Василий Викторович – канд. мед. наук, научный сотрудник отделения сердечно-сосудистой хирургии

634012 Томск, ул. Киевская, 111-А

Vasiliy V. Zatolokin – Cand. of Sci. (Med.), research associate, department of cardiothoracic surgery

111-А, Kievskaya str., Tomsk 634012

Vasiliy_zatolokin@mail.ru

https://orcid.org/0000-0003-1956-0692

Шипулин

В. М.

Shipulin

V. M.

Шипулин Владимир Митрофанович – доктор мед. наук, профессор, главный научный сотрудник аппарата управления

634012 Томск, ул. Киевская, 111-А

Vladimir M. Shipulin – Doct. of Sci. (Med.), Professor, chief scientific officer

111-А, Kievskaya str., Tomsk 634012

shipartphoto@gmail.com

https://orcid.org/0000-0002-0217-7737

Козлов

Б. Н.

Kozlov

B. N.

Козлов Борис Николаевич – доктор мед. наук, заведующий отделением сердечно-сосудистой хирургии

634012 Томск, ул. Киевская, 111-А

Boris N. Kozlov – Doct. of Sci. (Med.), Head of cardiothoracic surgery department, department of cardiothoracic surgery

111-А, Kievskaya str., Tomsk 634012

bnkozlov@yandex.ru

https://orcid.org/0000-0001-9887-8214

Мишкина

А. И.

Mishkina

A. I.

Мишкина Анна Ивановна – канд. мед. наук, научный сотрудник лаборатории радионуклидных методов исследования

634012 Томск, ул. Киевская, 111-А

Anna I. Mishkina – Cand. of Sci. (Med.), research associate, department of nuclear medicine

111-А, Kievskaya str., Tomsk 634012

https://orcid.org/0000-0002-1513-8614

Завадовский

К. В.

Zavadovsky

K. V.

Завадовский Константин Валерьевич – доктор мед. наук, заведующий отделом лучевой диагностики

634012 Томск, ул. Киевская, 111-А

Konstantin V. Zavadovsky – Doct. of Sci. (Med.), Head of imaging department, imaging department

111-А, Kievskaya str., Tomsk 634012

konstzav@gmail.com

Научно-исследовательский институт кардиологии, Томский национальный исследовательский медицинский центр Российской академии наукРоссияCardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of SciencesRussian Federation

2023

29062023

2742234

2023

Шипулин В.В., Гутор С.С., Андреев С.Л., Мочула А.В., Затолокин В.В., Шипулин В.М., Козлов Б.Н., Мишкина А.И., Завадовский К.В.

Shipulin V.V., Gutor S.S., Andreev S.L., Mochula A.V., Zatolokin V.V., Shipulin V.M., Kozlov B.N., Mishkina A.I., Zavadovsky K.V.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://medvis.rdsmedia.ru/jour/article/view/1241

Цель исследования

Цель исследования: определение связи между предоперационными показателями перфузии миокарда по данным ОФЭКТ (ПСМ) и характеристиками кровотока по маммарокоронарным шунтам (МКШ) по данным интраоперационной флоуметрии у пациентов с ишемической кардиомиопатией (ИКМП).

Материал и методы

Материал и методы. В исследование вошло 57 больных с ИКМП. Всем пациентам была выполнена предоперационная ПСМ с 99mTc-MIBI и интраоперационная флоуметрия кровотока по МКШ. Вычислялись следующие численные показатели флоуметрии: объемная скорость кровотока (Q), индекс сопротивления (PI), и диастолическое наполнение (DF). Проходимость анастомоза считалась удовлетворительной при нормальной форме флоуметрической волны, диастолически-доминантном кровенаполнении и значении Q более 11,5 мл/мин.

Результаты

Результаты. Пациенты были разделены на 2 группы: с удовлетворительной (n = 40) и неудовлетворительной (n = 17) проходимостью шунта по данным интраоперационной флоуметрии. По данным ПСМ различия между группами были выявлены в показателях перфузии покоя (summed rest score, SRS) – 20,7 ± 7,5% и 29,8 ± 4,0%; p = 0,002, общего дефицита перфузии (total perfusion deficit, TPD) в покое – 32,0 ± 11,4 и 43,0 ± 7,2; p = 0,01 и TPD в покое на территории передней нисходящей артерии – 20,7 ± 7,5 и 29,8 ± 4,0; р = 0,002. Кроме того, показатели флоуметрии различались у пациентов с хирургической реконструкцией левого желудочка и без нее (Q: 17 (11,5, 40,8) и 47 (25, 69,5) мл/мин, p = 0,013; PI: 3,9 (3,2, 7,4) и 2,4 (2,0, 3,6), p = 0,001, DF: 63,5 (44,5, 70,8) и 74 (66,0, 79,7)%, p = 0,019). TPD в покое, равный 26,85, был лучшим предиктором удовлетворительного состояния шунта (AUC = 0,771, чувствительность 83,3%, специфичность 78,1%).

Заключение

Заключение. Предоперационные характеристики перфузии миокарда ассоциированы с показателями кровотока по МКШ у пациентов с ишемической кардиомиопатией. TPD в покое и SRS могут являться потенциальными предикторами ранней недостаточности шунта.

Objective

Objective. The purpose of this study was to determine the association between preoperative myocardial perfusion data (obtained by SPECT) with transit time blood flow characteristics in left internal mammary artery (LIMA) to left anterior descending artery (LAD) grafts in patients with ischemic cardiomyopathy.

Methods

Methods. The study group consisted of 57 patients with ischemic cardiomyopathy. Intraoperative transit-time flow measurement (TTFM) of LIMA-LAD grafts were performed in all patients. All patients were also examined with preoperative stress and rest myocardial perfusion SPECT with 99m Tc-MIBI. Anastomotic patency was considered satisfactory with a normal waveform of blood flow, diastolic-dominant blood filling, and a mean flow value greater than 11.5 ml/min.

Results

Results. All 57 patients with LIMA-LAD grafts were divided into two groups; those with graft satisfactory patency (n = 40) and those with unsatisfactory patency (n = 17) as determined by TTFM. We found differences among these groups in values of global summed rest score (20.7 ± 7.5 vs. 29.8 ± 4.0; p = 0.002), global total perfusion deficit (TPD) at rest (32.0 ± 11.4 vs. 43.0 ± 7.2; p = 0.01), and regional TPD at rest in the LAD territory (20.7 ± 7.5 vs. 29.8 ± 4.0; p = 0.002). Additionally, the flow characteristics were different in patients with and without surgical left ventricle reconstruction (Q (ml/min): 17 (11.5, 40.8) vs. 47 (25, 69.5), p = 0.013; PI: 3.9 (3.2, 7.4) vs. 2.4 (2.0, 3.6), p = 0.001; DF (%): 63.5 (44.5, 70.8) vs. 74 (66.0, 79.7), p = 0.019). TPD at rest was the best predictor of the LIMA-LAD graft satisfactory: area under curve = 0.771, cut-off value = 26.85 with 83.3% sensitivity and 78.1% specificity.

Conclusions

Conclusions. Preoperative myocardial perfusion characteristics are associated with blood flow in LIMA-LAD graft in patients with ischemic cardiomyopathy. TPD at rest (assessed globally and in the LAD region) as well as global SRS value are potential predictors of early graft failure.

перфузионная сцинтиграфия миокардаинтраоперационная флоуметрияизмерение аортокоронарное шунтированиеишемическая болезнь сердцаишемическая кардиомиопатия

transit-time flow measurementmyocardial perfusion imagingcoronary artery bypass graftingcoronary artery diseaseischemic cardiomyopathy

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The authors declare that there are no conflicts of interest present.