Determinants of postinfarction remodeling affect outcome and left ventricular geometry after surgical treatment of ischemic cardiomyopathy.
OBJECTIVE
To identify the effects of the time between myocardial infarction and surgery, the site of infarction, mitral involvement on ventricular geometry, and clinical outcome in the treatment of ischemic cardiomyopathy in patients with heart failure.


METHODS
Sixty-nine consecutive patients with ischemic cardiomyopathy, indexed end-systolic volume > or =50 mL/m(2), ejection fraction < or =35%, and heart failure underwent surgery 81.9 +/- 100.8 months after myocardial infarction, using different techniques of ventricular restoration. Thirteen geometric parameters were studied pre- and postoperatively. Paired and unpaired t tests and general linear model for multivariate analysis were used to analyze subgroups. Logistic regression and Kaplan-Meier survival curves with pairwise log-rank were used to correlate covariates to clinical outcome.


RESULTS
Longer time to surgery and posterior necrosis linearly correlated with higher left ventricular volumes (r(2) =.66) and diameters (r(2) =.40). High grade of mitral regurgitation was always present in posterior infarctions. Hospital mortality was 4.3%. Complicated postoperative course was predicted by mitral surgery (P =.004) and longer time to surgery (P =.04). Survival was significantly lower in the posterior infarction (P =.0002) and mitral surgery (P =.001) subgroups. At a mean follow-up of 1.9 +/- 1.3 years, functional status and geometrical restoration are influenced by the studied covariates.


CONCLUSIONS
Longer time to surgery after myocardial infarction, its posterior location, and significant mitral regurgitation can affect left ventricular remodeling, surgical restoration, and clinical outcome in patients with ischemic cardiomyopathy.
Cirillo
Marco
M
Department of Cardiac Surgery, Echocardiography Laboratory, Poliambulanza Hospital, Brescia, Italy. cch-segretaria.poli@poliambulanza.it
Amaducci
Andrea
A
Brunelli
Federico
F
Dalla Tomba
Margherita
M
Parrella
Piervirgilio
P
Tasca
Giordano
G
Troise
Giovanni
G
Quaini
Eugenio
E
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000379:methods; D015150:Echocardiography, Doppler; D005260:Female; D006334:Heart Function Tests; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D017202:Myocardial Ischemia / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality; D011300:Preoperative Care / Q000379:methods; D011336:Probability; D011379:Prognosis; D012008:Recurrence; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome; D020257:Ventricular Remodeling / Q000502:physiology*