Functional changes after partial left ventriculectomy and mitral valve repair assessed by gated perfusion SPECT.
A myocardial remodeling in dilated cardiomyopathy (DCM) after partial left ventriculectomy (PLV) has been previously discussed. The aim of this study was to investigate the functional changes in the follow-up of patients with DCM undergoing PLV using electrocardiographically triggered perfusion SPECT (gated SPECT).


METHODS
Twelve DCM patients (10 men, 2 women; 56 +/- 9 y [mean +/- SD]), after successful PLV and mitral valve repair (PLV-MVR), were monitored by gated SPECT and echocardiography. Gated SPECT quantified end-diastolic volumes (EDV), end-systolic volumes (ESV), myocardial and scar volumes, as well as ejection fraction (EF) preoperatively, early (38 +/- 28 d), and late (296 +/- 130 d) after PLV-MVR.


RESULTS
EDV and ESV showed an immediate reduction after PLV-MVR (EDV from 542 +/- 90 mL to 350 +/- 81 mL, P < 0.001; ESV from 452 +/- 91 mL to 254 +/- 79 mL, P < 0.001) with no significant change in the late follow-up (EDV late, 316 +/- 63 mL; ESV late, 207 +/- 63 mL; both P = not significant vs. early follow-up). PLV-MVR immediately improved EF (preoperative, 16.8% +/- 5.5%; early, 28.8% +/- 7.6%; P = 0.003) with no significant change in the late follow-up (36.0% +/- 9.4%; P = not significant vs. early follow-up).


CONCLUSIONS
In this highly selected DCM patient group, gated perfusion SPECT assessed early responses in volumes and EF after PLV-MVR. However, although statistically nonsignificant in the small patient group, ESV and EDV were further decreased, whereas EF improved toward 1 y, coinciding with the improvement of clinical symptoms (New York Heart Association), potentially indicating a functional remodeling after PLV-MVR. Further studies in larger patient cohorts and longer follow-up are warranted.
Department of Nuclear Medicine, University Hospital, Münster, Germany. schafmi@uni-muenster.de
Michael
M
Schäfers
Jörg
J
Stypmann
Markus J
MJ
Wilhelm
Lars
L
Stegger
Peter
P
Kies
Sven
S
Hermann
Christoph
C
Schmidt
Günter
G
Breithardt
Hans H
HH
Scheld
Otmar
O
Schober
D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D015637:Gated Blood-Pool Imaging / Q000379:methods*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000601:surgery*; D011379:Prognosis; D020127:Recovery of Function / Q000502:physiology; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*