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End‐systolic volume following surgical ventricular reconstruction impacts survival in patients with ischaemic dilated cardiomyopathy
Author(s) -
Di Donato Marisa,
Castelvecchio Serenella,
Menicanti Lorenzo
Publication year - 2010
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1093/eurjhf/hfq020
Subject(s) - medicine , cardiology , dilated cardiomyopathy , heart failure , myocardial infarction , population , coronary artery disease , diastole , artery , blood pressure , environmental health
Aims A left ventricular end‐systolic volume (LVESV) ≥60 mL/m 2 has been shown to be associated with increased cardiac mortality after a reperfused myocardial infarction (MI). The reduction in LVESV following surgical ventricular reconstruction (SVR) is reported to be between 19% and 50% but its impact on prognosis is not well‐established. The aim of this study was therefore to assess the impact on survival of a residual LVESV index (LVESVI) of ≥ or <60 mL/m 2 following SVR. Methods and results All patients undergoing SVR at our Centre between July 2001 and March 2009 were eligible to be included in this study if they had a preoperative LVESVI of ≥60 mL/m 2 and an LVESVI measurement performed at discharge (7–10 days after surgery). Two hundred and sixteen patients (aged 64 ± 9 years, 33 women) satisfied these criteria. Coronary artery bypass graft was performed in 197 patients (91.2%) and mitral repair in 63 patients (29%). Left ventricular ESVI had decreased by 41% at discharge in the overall population. Patients were grouped according to the residual LVESVI at discharge as follows: Group 1, LVESVI ≥ 60 mL/m 2 ( n = 71), and Group 2, LVESVI < 60 mL/m 2 ( n = 145). In both groups, LVESVI decreased significantly with respect to baseline, by 29% in Group 1 and by 47% in Group 2. At multivariate analysis, the presence of a non‐Q‐wave MI and a preoperative internal diastolic diameter of 65 mm were the strongest predictors of a residual post‐operative LVESVI of ≥60 mL/m 2 . Risk of all‐cause death was significantly higher in Group 1. Post‐operative LVESVI of ≥60 mL/m 2 was an independent predictor of mortality at follow‐up [Exp( B ) = 10.7, CI: 2.67–42.9, P = 0.001]. Conclusion Our findings confirm the role of LVESVI in predicting survival following SVR; the lack of additional improvement in survival with SVR observed in the STICH trial might be due to the inadequate volume reduction (−19%).