Baseline left ventricular volume and shape as determinants of reverse remodeling induced by surgical ventricular reconstruction

M Di Donato, S Castelvecchio, D Burkhoff, A Frigiola, A Raweh, L Menicanti
Ann Thorac Surg 2011;92:1565-1571

BACKGROUND: Early postoperative data show that surgical ventricular reconstruction (SVR) induces reverse remodelling (RR) in dilated ischemic cardiomyopathy. The stability of these results at follow-up is debated. This retrospective study determined whether RR was stable at follow-up and the role, if any, of preoperative left ventricle volume and shape on SVR-induced changes. METHODS: The study group comprised 220 patients (age, 64 +/- 9 years) with an echocardiography study at baseline, discharge, and at follow-up. RR was defined as a reduction of left ventricular end-systolic volume index (ESVI) at follow-up exceeding 15% vs baseline. RESULTS: Reverse remodelling occurred in 162 patients (74%); the ESVI at follow-up in the remaining 58 (26%) was equal to or greater than at baseline (no-RR). At baseline, the no-RR patients had lower volumes and higher ejection fraction; at the 1-week post-SVR evaluation, all patients reached significant ESV reduction, but at follow-up, the no-RR patients had dilated and showed significantly higher volumes and lower ejection fraction vs patients with RR. New York Heart Association class improved in both groups (2.6 +/- 0.6 to 1.6 +/- 0.5 and 2.5 +/- 0.8 to 1.8 +/- 0.7, respectively, p = 0.0001). Baseline ESVI less than 73 mL/m(2), apical axis less than 4.35 cm, and conicity index less than 0.759 were predictors of no-RR. CONCLUSIONS: A relatively small ESVI and a more physiologic apical shape (conical) are predictors of no-RR after SVR. Despite lack of RR, the ESV at follow-up is not severely enlarged, which explains the good survival rate in these patients.


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