Use of quantitative analysis of remote myocardial fibrosis with delayed-enhancement magnetic resonance imaging to predict outcomes after surgical ventricular restoration for ischemic cardiomyopathy.
OBJECTIVE
Preserved myocardial function remote from surgical site is crucial for good outcome after surgical ventricular restoration in ischemic cardiomyopathy. We hypothesized that left ventricular scarring untouched by operation would negatively affect postoperative outcome.


METHODS
In 15 consecutive patients (mean age 61 +/- 12 years, mean left ventricular ejection fraction 20% +/- 7.5%), left ventricular assessments by magnetic resonance imaging and right heart catheterization were performed before and after operation. Left ventricular basal scarring remote from surgical exclusion site was quantified from hyperenhancement area on preoperative delayed-enhancement magnetic resonance imaging as percentage of fibrosis (total infarct size relative to ventricular mass).


RESULTS
Calculated percentage of fibrosis varied from 0% to 29.9% (mean 12% +/- 9.6%). Percentage of fibrosis linearly correlated with significantly worse postoperative hemodynamic variables and left ventricular function recovery: left ventricular ejection fraction (P = .0005, R = -0.79), left ventricular end-systolic volume index (P = .05, R = 0.51), mean pulmonary arterial pressure (P = .004, R = 0.70), pulmonary capillary wedge pressure (P = .009, R = 0.65), and cardiac index (P = .005, R = -0.69). At mean 30-month follow-up, 4 patients with recurrent heart failure had significantly greater percentage of fibrosis than did those without recurrence (19% +/- 8.2% vs 8.8% +/- 8.6%, P = .04).


CONCLUSIONS
Amount of myocardial scarring at left ventricular base affected postoperative left ventricular function and hemodynamic improvements. Preoperative quantitative assessment of remote myocardial status with delayed-enhancement magnetic resonance imaging may predict outcomes for patients undergoing surgical ventricular restoration.
Takeda
Koji
K
Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Matsumiya
Goro
G
Matsue
Hajime
H
Hamada
Seiki
S
Sakaki
Masayuki
M
Sakaguchi
Taichi
T
Fujita
Tomoyuki
T
Sawa
Yoshiki
Y
D000368:Aged; D009202:Cardiomyopathies / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005355:Fibrosis; D006352:Heart Ventricles / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D009206:Myocardium / Q000473:pathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology; D016277:Ventricular Function, Left