Importance of the area of fibrosis at midterm evolution of patients submitted to ventricular reconstruction.
BACKGROUND
Although it is acknowledged that the ventricular reconstruction surgery (VRS) can promote reverse remodeling, new studies are necessary to define the influence of the left ventricular (LV) area of fibrosis.


OBJECTIVE
To evaluate whether the extension of the area of fibrosis of the LV is important in the LV functional recovery after the surgery and correlate it with clinical factors.


METHODS
Prospective analysis of 82 patients with ventricular dysfunction submitted to VRS. We analyzed the importance of the clinical characteristics and the amount of fibrosis was assessed, measured by cardiac magnetic resonance (CMR) as small, medium and large.


RESULTS
All patients were followed for 36 months, with a mortality of 6%. The amount of medium fibrosis was 25.8% +/- 13.6%. There was improvement in the left ventricular ejection fraction (LVEF), from 36.9% +/- 6.8% to 48.2% +/- 8.2% (p < 0.001). There was an inverse association between the amount of fibrosis and the increase in LVEF (r = -0.83, p < 0.0001). There was a decrease in the LV end-systolic volume of 43.3 +/- 8.2 ml/m(2) (p < 0.001). There was an improvement in heart failure symptoms, except in patients with large areas of fibrosis (p = 0.45). The independent predictors for events were: fibrotic area (p = 0.01), age (p = 0.01), LV end-systolic volume (p = 0.03) and LVEF (p = 0.02). The event-free follow-up was different in relation to the area of fibrosis (p < 0.01).


CONCLUSIONS
In patients with ventricular dysfunction, the extension of the area of fibrosis was an independent predictor of the LV functional recovery after the VRS. The combination of cardiac MRI and clinical parameters can help in the indication for VRS.
Ribeiro
Gustavo Calado de Aguiar
GC
Clínica Cárdio Cirúrgica Campinas, Radiologia Clínica Campinas, Hospital Samaritano de Campinas, Campinas, SP, Brasil.
Lopes
Mauricio
M
Antoniali
Fernando
F
Nunes
Ana
A
Costa
Cledicyon Eloy
CE
Fernandes
Juliano L
JL
D000368:Aged; D004719:Endomyocardial Fibrosis / Q000473:pathology*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function / Q000502:physiology*; D013318:Stroke Volume / Q000502:physiology*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D020257:Ventricular Remodeling / Q000502:physiology*