Key result
Infarct exclusion surgery reduces left ventricular end-systolic volume index by ~42% at follow-up.
Why the study?
Accurate volume quantification is required to determine the impact of infarct exclusion surgery due to complicated geometric changes in ischemic cardiomyopathy patients.
Does infarct exclusion surgery improve left ventricular volume and function as assessed by real-time 3-dimensional echocardiography in patients with ischemic cardiomyopathy?
Cohort (n=30)
Does infarct exclusion surgery improve left ventricular volume and function as assessed by real-time 3-dimensional echocardiography in patients with ischemic cardiomyopathy?
Real-time 3-dimensional echocardiography effectively quantifies significant improvements in left ventricular volume and ejection fraction following infarct exclusion surgery, which correlate with symptomatic improvement.
May support infarct exclusion for LV remodeling in ischemic cardiomyopathy; leaves open need for randomized confirmation of clinical outcomes.
BACKGROUND: Infarct exclusion (IE) surgery, a technique of left ventricular (LV) reconstruction for dyskinetic or akinetic LV segments in patients with ischemic cardiomyopathy, requires accurate volume quantification to determine the impact of surgery due to complicated geometric changes. METHODS AND RESULTS: Thirty patients who underwent IE (mean age 61+/-8 years, 73% men) had epicardial real-time 3-dimensional echocardiographic (RT3DE) studies performed before and after IE. RT3DE follow-up was performed transthoracically 42+/-67 days after surgery in 22 patients. Repeated measures ANOVA was used to compare the values before and after IE surgery and at follow-up. Significant decreases in LV end-diastolic (EDVI) and end-systolic (ESVI) volume indices were apparent immediately after IE and in follow-up (EDVI 99+/-40, 67+/-26, and 71+/-31 mL/m(2), respectively; ESVI 72+/-37, 40+/-21, and 42+/-22 mL/m(2), respectively; P:<0.05). LV ejection fraction increased significantly and remained higher (0.29+/-0.11, 0.43+/-0.13, and 0.42+/-0.09, respectively, P:<0.05). Forward stroke volume in 16 patients with preoperative mitral regurgitation significantly improved after IE and in follow-up (22+/-12, 53+/-24, and 58+/-21 mL, respectively, P:<0.005). New York Heart Association functional class at an average 285+/-144 days of clinical follow-up significantly improved from 3.0+/-0.8 to 1.8+/-0.8 (P:<0.0001). Smaller end-diastolic and end-systolic volumes measured with RT3DE immediately after IE were closely related to improvement in New York Heart Association functional class at clinical follow-up (Spearman's rho=0.58 and 0.60, respectively). CONCLUSIONS: RT3DE can be used to quantitatively assess changes in LV volume and function after complicated LV reconstruction. Decreased LV volume and increased ejection fraction imply a reduction in LV wall stress after IE surgery and are predictive of symptomatic improvement.
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Qin et al. (2000) conducted a cohort in Ischemic cardiomyopathy (n=30). Infarct exclusion surgery vs. Preoperative baseline was evaluated on Left ventricular end-diastolic and end-systolic volume indices (p=<0.05). Infarct exclusion surgery significantly decreased left ventricular end-diastolic volume index (99 to 71 mL/m2) and end-systolic volume index (72 to 42 mL/m2) at follow-up (P<0.05).
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