title: Does quantitative left ventricular regional wall motion change after fibrous tissue resection in endomyocardial fibrosis?
abstract: 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.
authors.affiliation: Cardiomyopathy Unit, Heart Institute (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil. verasalemi@uol.com.br
authors.forename: Vera Maria Cury
authors.initials: VM
authors.lastname: Salemi
authors.forename: Fabio
authors.initials: F
authors.lastname: Fernandes
authors.forename: Raquel
authors.initials: R
authors.lastname: Sirvente
authors.forename: Luciano
authors.initials: L
authors.lastname: Nastari
authors.forename: Leonardo Vieira
authors.initials: LV
authors.lastname: Rosa
authors.forename: Cristiano A
authors.initials: CA
authors.lastname: Ferreira
authors.forename: José Luiz Barros
authors.initials: JL
authors.lastname: Pena
authors.forename: Michael H
authors.initials: MH
authors.lastname: Picard
authors.forename: Charles
authors.initials: C
authors.lastname: Mady
mesh_terms: 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*