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Ann Thorac Surg 2003;76:1576-1585
© 2003 The Society of Thoracic Surgeons

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Original article: cardiovascular

Noninvasive assessment of cardiac mechanics and clinical outcome after partial left ventriculectomy

^a Department of Radiology, Cleveland, OH, USA
^b Department of Thoracic and Cardiovascular Surgery, Cleveland, OH, USA
^c Department of Cardiovascular Medicine, Cleveland, OH, USA
^d Department of Biomedical Engineering, Cleveland, OH, USA
^e Department of Biostatistics and Epidemiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA

Accepted for publication May 28, 2003.

^* Address reprint requests to Dr White, Section of Cardiovascular Imaging, Division of Radiology, Desk HB6, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195, USA.
e-mail: whiter{at}ccisd1.ccf.org

BACKGROUND: Partial left ventriculectomy (PLV) was developed as a therapy for end-stage heart failure, but results were variable with few a priori predictors of outcome. Little is known about its effects on myocardial mechanics and their relation to clinical outcome.

METHODS: Twenty-four dilated cardiomyopathy patients underwent cardiac magnetic resonance imaging (MRI) before PLV, and 3 and 12 months after surgery. Left ventricular (LV) circumferential shortening and wall stress were computed at three short-axis levels. Exploratory outcome analysis grouped patients according to the timing of adverse cardiac events postsurgery.

RESULTS: LV mass and volume were decreased at each postsurgical time point (all p < 0.01). At 3 months, regional wall stress was reduced at all short-axis levels; but by 12 months stress was reduced from baseline only at the apex. Circumferential shortening was increased significantly at both postsurgical time points at each level. On average, septal shortening was negative (stretching) before surgery, but increased significantly, and was positive, postsurgery. Exploratory outcome analysis found that negative values of basal septum circumferential shortening before surgery increased the probability of event-free survival beyond 6 months.

CONCLUSIONS: Regional heterogeneity of LV myocardial function, associated with dilated cardiomyopathy, was diminished after PLV but was also related to patient outcome. MRI with tissue tagging is useful for assessing the efficacy of surgical therapies for congestive heart failure.

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Ann. Thorac. Surg. 2003 76: 1585-1586. [Extract] [Full Text] [PDF]

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