Impact of surgical ventricular restoration on diastolic function: implications of shape and residual ventricular size.
BACKGROUND
Limited data are available on left ventricle (LV) diastolic function in patients with ischemic dilated cardiomyopathy submitted to surgical ventricular restoration (SVR). The purpose of this study was to assess postoperative diastolic function changes and identify potential predictors of its worsening.


METHODS
One hundred and forty-six patients (65 +/- 9 years) with previous anterior myocardial infarction were evaluated before and after SVR. Hemodynamic and geometric parameters including the sphericity index and conicity index were measured. Diastolic function was explored using the transmitral flow velocity pattern, and four classes were defined: normal, abnormal relaxation, pseudonormal, and restrictive pattern. Diastolic function was defined as unchanged (no difference in diastolic pattern), improved (at least one class less), or worsened (at least one class more or, in the case of preoperative restrictive pattern, an early transmitral flow velocity to atrial flow velocity [E/A] ratio increase of at least 20%).


RESULTS
The filling pattern before SVR was normal in 7 patients (4.8%), abnormal relaxation in 99 (68%), pseudonormal in 28 (19%), and restrictive in 12 (8.2%). After SVR, the filling pattern was unchanged in 105 patients (72%), improved in 14 (9.6%), and worsened in 27 (18.4%). Based on the univariate analysis, the preoperative conicity index and the end-diastolic volume difference (the result of surgical volume reduction) were associated with a diastolic pattern worsening.


CONCLUSIONS
Diastolic function did not change or improve in the majority of patients. In the minority of patients who experienced worsening, this was associated with the preoperative LV shape and residual volume.
Castelvecchio
Serenella
S
Department of Cardiac Surgery, IRCCS, San Donato Hospital, Milan, Italy.
Menicanti
Lorenzo
L
Ranucci
Marco
M
Di Donato
Marisa
M
D000368:Aged; D000704:Analysis of Variance; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D003326:Coronary Circulation / Q000502:physiology; D003971:Diastole / Q000502:physiology*; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D009929:Organ Size; D011336:Probability; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D013318:Stroke Volume; D016019:Survival Analysis; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D020257:Ventricular Remodeling / Q000502:physiology*