Serial change in perfusion–metabolism mismatch after coronary artery bypass grafting

Abstract

Objective Myocardial ischemia is known to suppress fatty acid metabolism and favor glucose metabolism. However, changes in myocardial metabolism after coronary revascularization are not fully elucidated. Methods Thirty-eight patients with coronary artery disease were retrospectively enrolled. These patients had undergone stress perfusion single photon emission computed tomography (SPECT) and 123I-BMIPP SPECT in both the short-term (6.4 ± 4.7 months) and mid-term (29.9 ± 7.2 months) after isolated coronary artery bypass grafting. Tracer uptake was graded using a 17-segment, 5-point scoring model. Serial changes in SRS (summed rest score), SDS (summed difference score), the BMIPP score (total defect score of BMIPP), and the mismatch score (BMIPP score–SRS) were evaluated. In addition, persistent perfusion–metabolism mismatch (PM) was defined as mismatch score minus SDS of 3 or more during the mid-term postoperative period. The clinical parameters associated with PM were examined. Results From short- to mid-term postoperative period, the extent of infarcted myocardium (SRS) did not change significantly (7.8 ± 8.0 to 7.1 ± 7.0, P = 0.117). The extent of ischemic myocardium (SDS), the BMIPP score and the mismatch score, which reflects perfusion–metabolism mismatch, were significantly improved (2.0 ± 2.8 to 0.7 ± 1.0, P = 0.010; 12.2 ± 9.0 to 9.5 ± 7.9, P < 0.001; 4.4 ± 3.7 to 2.5 ± 2.6, P < 0.001; respectively). Remarkably, perfusion–metabolism mismatch persisted in 13 patients (34%) even in the mid-term postoperative period. eGFR and SYNTAX score were independent predictors of persistent perfusion–metabolic mismatch in multivariable analysis (OR = 0.951, 95% CI 0.898–0.985, P = 0.010 and OR = 1.126, 95% CI 1.011–1.254, P = 0.031, respectively). The mismatch score both in the short- and mid-term significantly correlated with SYNTAX score (r = 0.400 and r = 0.472, respectively). Conclusions Fatty acid metabolism disturbance improved from short- to mid-term postoperative period in patients with successful reperfusion by coronary artery bypass grafting. However, in patients with severe atherosclerosis, impaired fatty acid metabolism was sustained until the mid-term postoperative period, even though ischemia had resolved.

Plasma Exosome miRNAs Profile in Patients With ST-Segment Elevation Myocardial Infarction

“…This was performed using miRPath v3.0 with previous experimental support ( 21 ). Aerobic fatty acid biosynthesis and metabolism were impaired, while the glycolytic system was augmented during myocardial ischemia ( 22 ). As shown in the network plot ( Figure 3E ), miR-181a-3p targeting genes were tenascin C (TNC), laminin subunit alpha 4 (LAMA4), collagen type V alpha 1 chain (COL5A1), and thrombospondin 2 (THBS2).…”

Revascularisation for Ischaemic Cardiomyopathy

“…10 Restoration of normal myocardial blood flow leads to an improvement in metabolic function. [11][12][13] In addition, revascularisation has the potential to reverse LV remodelling, leading to an improvement in LV volume and contractile function. Several functional features of hibernation have been identified to assess myocardial viability and aid in identifying patients who will experience an improvement in LV function.…”

“…[ 10 ] Restoration of normal myocardial blood flow leads to an improvement in metabolic function. [ 11 – 13 ]…”

Cost-Effectiveness of Coronary Artery Bypass Grafting (CABG) versus Percutaneous Coronary Intervention (PCI) as an add-on strategy to Optimal Medical Therapy (OMT) in Severe Ischemic Cardiomyopathy

“…Revascularization holds particular promise for this patient population, as it offers to limit and reverse the ischemia-driven progression of ventricular damage with ultimate goal to prevent the onset of a decompensated HF state, marked by diminished quality of life, extensive healthcare utilization, and ultimately, premature death [9][10][11] .…”

“…Although the introduction of optimal medical therapy (OMT) and preventive device therapy has marked a significant advancement in the management of ICM and heart failure with reduced ejection fraction (HFrEF), patients with severe ventricular dysfunction, as characterized by left ventricular ejection fraction (LVEF) of 35% or lower, remain at high risk for adverse events due to recurrent ischemic insults 7,8 . Revascularization holds particular promise for this patient population, as it offers to limit and reverse the ischemia-driven progression of ventricular damage with ultimate goal to prevent the onset of a decompensated HF state, marked by diminished quality of life, extensive healthcare utilization, and ultimately, premature death 9–11 .…”