Key result
LV restoration achieving <35% residual scar perimeter is linked to ~3 additional cardiac event-free years.
Why the study?
Post-infarction myocardial scar is associated with adverse LV remodeling and negatively affects prognosis, leading authors to evaluate the impact of scar-exclusive left ventricular restoration on long-term outcomes in ischemic heart failure.
Does achieving a residual scar perimeter <35% during left ventricular restoration improve long-term outcomes in patients with ischemic heart failure?
Cohort (n=108)
Does achieving a residual scar perimeter <35% during left ventricular restoration improve long-term outcomes in patients with ischemic heart failure?
Achieving a residual scar perimeter of <35% during left ventricular restoration for ischemic heart failure significantly improves long-term cardiac event-free survival and left ventricular diastolic function.
Residual scar perimeter <35% was associated with longer event-free survival after LV restoration; leaves open whether this target should guide surgery in ischemic HF.
OBJECTIVE: Post-infarction myocardial scar as detected by cardiac magnetic resonance (CMR) is associated with adverse left ventricular (LV) remodeling and negatively affects the prognosis. We sought to analyze the impact of left ventricular restoration (LVR) with asynergic scar exclusion on long-term outcomes for patients with ischemic heart failure (IHF). METHODS: From January 2005, 134 consecutive patients with IHF underwent scar-exclusive LVR. Among the 131 survivors, 108 patients had paired late gadolinium enhancement (LGE)-CMR preoperatively and one year after, and represent the study population. Patients were divided into two groups according to whether their post-LVR residual percentage of scarred LV perimeter was <35% (%Scar <35; n = 55) or more (%Scar ≥35; n = 53). We compared the two groups, by looking at LGE-CMR outcomes, and at long-term survival and cardiac event (hospitalization for cardiac causes)-free survival. RESULTS: Postoperative LV end-systolic volume index decreased significantly and ejection fraction increased with significant increase in stroke volume index (P < 0.05 for both). LV diastolic function of the left atrial volume index was significantly improved in patients with residual %Scar <35 than in those with %Scar ≥35 (P interaction = 0.005). Median survival in patients with residual %Scar <35 and ≥ 35 were 8.3 (4.5-12.2) years and 6.8 (1.8-11.8) years respectively (P = 0.106). Median cardiac event-free survival in patients with %Scar <35 and ≥ 35 were 8.0 (3.9-12.1) years and 4.8 (0.8-8.8) years respectively (P < 0.001). CONCLUSIONS: Scar-exclusive LVR yielded sustainable improvement in LV function and favorable long-term survival regardless of the extent of residual scar. The LVR should be performed to attain scar exclusion in the surgical treatment for IHF, which in turn might protectively affect LV diastolic function and cardiac event-free survival.
No takes yet. Share an insight, caveat, or question.
Cho et al. (2023) conducted a cohort in Ischemic heart failure (n=108). Left ventricular restoration with residual scar <35% vs. Left ventricular restoration with residual scar ≥35% was evaluated on Median cardiac event-free survival (years) (p=<0.001). Left ventricular restoration achieving a residual scar perimeter <35% significantly improved median cardiac event-free survival compared to ≥35% (8.0 vs 4.8 years; P<0.001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: