Effects of surgical ventricular restoration on left ventricular function: dynamic MR imaging.
OBJECTIVE
To retrospectively evaluate with dynamic magnetic resonance (MR) imaging the changes in global and regional left ventricular (LV) function after surgical ventricular restoration (SVR) performed in chronic ischemic heart disease patients with large nonaneurysmal or aneurysmal postmyocardial infarction zones.


METHODS
The study was performed with institutional review board approval, and a waiver of individual informed consent was obtained. The study was HIPAA compliant. Patients (83 men, 22 women; mean age, 61 years +/- 9 [standard deviation]) were evaluated with MR imaging before and after SVR as follows: pre-SVR examination (n = 105; 25 days +/- 39 before SVR; median, 7 days; range, 1-189 days), early post-SVR examination (n = 95, 7 days +/- 3 after SVR), and late post-SVR (n = 35, 313 days +/- 158 after SVR). Cine MR imaging allowed calculation of ejection fraction and rate-corrected velocity of circumferential fiber shortening (Vcf(C)) for global LV functional evaluation, whereas tagged MR imaging (spatial modulation of magnetization with harmonic phase analysis) permitted assessment of regional circumferential strain (E(C)) with coronary distribution. Vcf(C) and E(C) were computed at both LV base- and mid-LV short-axis levels remote from the site of anteroapical SVR.


RESULTS
Prior to SVR, LV dilatation and diminished global and regional LV function were observed. At early post-SVR examination, Vcf(C) had improved significantly but E(C) showed a worsening trend overall, although only E(C )of the right coronary artery at the mid-LV level worsened significantly. At late post-SVR examination, Vcf(C) values were improved when compared with pre-SVR values, although E(C) showed no statistically significant improvement. When compared with that at early post-SVR examination, however, E(C) showed significant improvement in two segments: left anterior descending artery and right coronary artery at mid-LV level.


CONCLUSIONS
Although volume-based indexes of global LV function improve significantly after SVR, regional LV function did not improve significantly; there was evidence of continued LV remodeling after SVR.
Carmichael
Brett B
BB
Center for Integrated Non-Invasive Cardiovascular Imaging of the Department of Radiology, Cleveland Clinic Foundation, Desk Hb6, 9500 Euclid Ave, Cleveland, OH 44195, USA.
Setser
Randolph M
RM
Stillman
Arthur E
AE
Lieber
Michael L
ML
Smedira
Nicholas G
NG
McCarthy
Patrick M
PM
Starling
Randall C
RC
Young
James B
JB
Weaver
Joan A
JA
Lawrence
Angel G
AG
White
Richard D
RD
D006348:Cardiac Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*