Key result
Specific myocardial morphological markers predict adverse 1-year postoperative left ventricular remodeling.
Why the study?
Predictors of postoperative left ventricular remodeling in patients with ischemic cardiomyopathy were not identified by echocardiography data alone.
Cohort (n=48)
Morphological features from intraoperative biopsies, such as inflammatory infiltration and fibrosis, can predict negative postoperative left ventricular remodeling in patients with ischemic cardiomyopathy.
May support postoperative risk stratification via biopsy in ischemic cardiomyopathy; hypothesis-generating for prospective validation before practice change.
Functional morphology of left ventricular (LV) myocardium and right atrium(RA) auricle intraoperative biopsies from 48 patients with ischemic cardiomyopathy (ICMP) was studied. In the early (1 year) postoperative follow-up period all the patients were divided into 2 groups: those with positive and negative dynamics of end diastolic volume index and effusion fraction (EF) of LV. Retrospective analysis of echocardiography (EchoCG) data did not allow to reveal predictors of postoperative heart remodeling in both groups of the patients. On the contrary, drawing clinical-morphological parallels of negative dynamics of the early postoperative period showed that presence of diffuse, lymphocytic-macrophage inflammatory infiltration of myocardial stroma in combination with pronounced fibrosis, low values of trophic index ( 1000 mcm) and Kernogan index (> 1,6) of LV myocardium were morphological predictors of postoperative heart remodeling.
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Vitaly A. Kazakov (2009) conducted a cohort in ischemic cardiomyopathy (n=48). Myocardial inflammatory infiltration, fibrosis, low trophic index, and Kernogan index > 1.6 vs. Absence of these morphological predictors was evaluated on Postoperative heart remodeling (negative dynamics of end diastolic volume index and ejection fraction). Myocardial inflammatory infiltration, pronounced fibrosis, low trophic index, and Kernogan index >1.6 were identified as morphological predictors of negative postoperative heart remodeling at 1 year.
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