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Abstract：
BACKGROUND: We aim to provide a comprehensive review of the current state of knowledge of myocardial viability assessment in patients undergoing coronary artery bypass grafting (CABG), with a focus on the clinical markers of viability for each imaging modality. We also compare mortality between patients with viable myocardium and those without viability who undergo CABG.
METHODS: A systematic database search with meta-analysis was conducted of comparative original articles (both observations and randomized controlled studies) of patients undergoing CABG with either viable or nonviable myocardium, in EMBASE, MEDLINE, Cochrane database, and Google Scholar, from inception to 2022. Imaging modalities included were dobutamine stress echocardiography (DSE), cardiac magnetic resonance (CMR), single-photon emission computed tomography (SPECT), and positron emission tomography (PET).
RESULTS: A total of 17 studies incorporating a total of 2317 patients were included. Across all imaging modalities, the relative risk of death post-CABG was reduced in patients with versus without viability (random-effects model: odds ratio: 0.42; 95% confidence interval: 0.29-0.61; p < 0.001). Imaging for myocardial viability has significant clinical implications as it can affect the accuracy of the diagnosis, guide treatment decisions, and predict patient outcomes. Generally, based on local availability and expertise, either SPECT or DSE should be considered as the first step in evaluating viability, while PET or CMR would provide further evaluation of transmurality, perfusion metabolism, and extent of scar tissue.
CONCLUSIONS: The assessment of myocardial viability is an essential component of preoperative evaluation in patients with ischemic heart disease undergoing surgical revascularization. Careful patient selection and individualized assessment of viability remain paramount.
METHODS: A systematic database search with meta-analysis was conducted of comparative original articles (both observations and randomized controlled studies) of patients undergoing CABG with either viable or nonviable myocardium, in EMBASE, MEDLINE, Cochrane database, and Google Scholar, from inception to 2022. Imaging modalities included were dobutamine stress echocardiography (DSE), cardiac magnetic resonance (CMR), single-photon emission computed tomography (SPECT), and positron emission tomography (PET).
RESULTS: A total of 17 studies incorporating a total of 2317 patients were included. Across all imaging modalities, the relative risk of death post-CABG was reduced in patients with versus without viability (random-effects model: odds ratio: 0.42; 95% confidence interval: 0.29-0.61; p < 0.001). Imaging for myocardial viability has significant clinical implications as it can affect the accuracy of the diagnosis, guide treatment decisions, and predict patient outcomes. Generally, based on local availability and expertise, either SPECT or DSE should be considered as the first step in evaluating viability, while PET or CMR would provide further evaluation of transmurality, perfusion metabolism, and extent of scar tissue.
CONCLUSIONS: The assessment of myocardial viability is an essential component of preoperative evaluation in patients with ischemic heart disease undergoing surgical revascularization. Careful patient selection and individualized assessment of viability remain paramount.
摘要：
背景：我们旨在对冠状动脉旁路移植术（CABG）患者的心肌活力评估知识的现状进行全面综述，重点关注每种成像模式的可行性临床标志物。我们还比较了有存活心肌和无存活心肌的患者接受CABG的死亡率。
方法：对接受有存活或无存活心肌的CABG患者的比较原始文章（观察和随机对照研究）进行了系统的数据库搜索，并进行了荟萃分析。在EMBASE,MEDLINE,Cochrane数据库,和谷歌学者，从成立到2022年。成像方式包括多巴酚丁胺负荷超声心动图（DSE），心脏磁共振（CMR），单光子发射计算机断层扫描（SPECT），和正电子发射断层扫描（PET）。
结果：共纳入17项研究，共纳入2317名患者。在所有成像模式中，有生活能力的患者与无生活能力的患者相比,CABG后的相对死亡风险降低(随机效应模型:比值比:0.42;95%置信区间:0.29~0.61;p<0.001).心肌存活成像具有重要的临床意义，因为它可以影响诊断的准确性。指导治疗决策，并预测患者的预后。一般来说,根据当地的可用性和专业知识，SPECT或DSE应被视为评估生存能力的第一步，而PET或CMR将提供跨壁性的进一步评估，灌注代谢，和疤痕组织的范围。
结论：对于接受手术血运重建的缺血性心脏病患者，心肌生存力评估是术前评估的重要组成部分。仔细的患者选择和对生存能力的个性化评估仍然至关重要。
方法：对接受有存活或无存活心肌的CABG患者的比较原始文章（观察和随机对照研究）进行了系统的数据库搜索，并进行了荟萃分析。在EMBASE,MEDLINE,Cochrane数据库,和谷歌学者，从成立到2022年。成像方式包括多巴酚丁胺负荷超声心动图（DSE），心脏磁共振（CMR），单光子发射计算机断层扫描（SPECT），和正电子发射断层扫描（PET）。
结果：共纳入17项研究，共纳入2317名患者。在所有成像模式中，有生活能力的患者与无生活能力的患者相比,CABG后的相对死亡风险降低(随机效应模型:比值比:0.42;95%置信区间:0.29~0.61;p<0.001).心肌存活成像具有重要的临床意义，因为它可以影响诊断的准确性。指导治疗决策，并预测患者的预后。一般来说,根据当地的可用性和专业知识，SPECT或DSE应被视为评估生存能力的第一步，而PET或CMR将提供跨壁性的进一步评估，灌注代谢，和疤痕组织的范围。
结论：对于接受手术血运重建的缺血性心脏病患者，心肌生存力评估是术前评估的重要组成部分。仔细的患者选择和对生存能力的个性化评估仍然至关重要。
