Does quantitative left ventricular regional wall motion change after fibrous tissue resection in endomyocardial fibrosis?
OBJECTIVE
We compared left ventricular regional wall motion, the global left ventricular ejection fraction, and the New York Heart Association functional class pre- and postoperatively.


BACKGROUND
Endomyocardial fibrosis is characterized by fibrous tissue deposition in the endomyocardium of the apex and/or inflow tract of one or both ventricles. Although left ventricular global systolic function is preserved, patients exhibit wall motion abnormalities in the apical and inferoapical regions. Fibrous tissue resection in New York Heart Association FC III and IV endomyocardial fibrosis patients has been shown to decrease morbidity and mortality.


METHODS
We prospectively studied 30 patients (20 female, 30+/-10 years) before and 5+/-8 months after surgery. The left ventricular ejection fraction was determined using the area-length method. Regional left ventricular motion was measured by the centerline method. Five left ventricular segments were analyzed pre- and postoperatively. Abnormality was expressed in units of standard deviation from the mean motion in a normal reference population.


RESULTS
Left ventricular wall motion in the five regions did not differ between pre- and postoperative measurements. Additionally, the left ventricular ejection fraction did not change after surgery (0.45+/-0.13% x 0.43+/-0.12% pre- and postoperatively, respectively). The New York Heart Association functional class improved to class I in 40% and class II in 43% of patients postoperatively (p<0.05).


CONCLUSIONS
Although endomyocardial fibrosis patients have improved clinical symptoms after surgery, the global left ventricular ejection fraction and regional wall motion in these patients do not change. This finding suggests that other explanations, such as improvements in diastolic function, may be operational.
Salemi
Vera Maria Cury
VM
Cardiomyopathy Unit, Heart Institute (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil. verasalemi@uol.com.br
Fernandes
Fabio
F
Sirvente
Raquel
R
Nastari
Luciano
L
Rosa
Leonardo Vieira
LV
Ferreira
Cristiano A
CA
Pena
José Luiz Barros
JL
Picard
Michael H
MH
Mady
Charles
C
D000328:Adult; D003971:Diastole / Q000502:physiology; D004719:Endomyocardial Fibrosis / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000503:physiopathology*; D011446:Prospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013318:Stroke Volume / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000503:physiopathology*