Significance of left ventricular diastolic function on outcomes after surgical ventricular restoration.
BACKGROUND
Surgical ventricular restoration (SVR) has been introduced to restore the dilated left ventricular (LV) chamber and improve LV systolic function; however, SVR has also been reported to detrimentally affect LV diastolic properties. We sought to investigate the impact of preoperative LV diastolic function on outcomes after SVR in patients with heart failure.


METHODS
Sixty-seven patients (60 +/- 14 years) with LV systolic dysfunction (LV ejection fraction, 0.27 +/- 0.10) underwent SVR. They were evaluated by echocardiography preoperatively, and early (<or=1 month) and late (mean, 3.4 years) after surgery. Patients were divided into three groups according to the preoperative diastolic filling patterns of transmitral flow (impaired relaxation, pseudonormal, and restrictive filling patterns).


RESULTS
Patients in the restrictive group showed far greater cardiovascular mortality than the other two groups (p < 0.0001). The multivariate analysis showed that preoperative restrictive filling pattern was a predominant predictor for adjusted cardiovascular death (p = 0.023; hazard ratio = 3.0). Left ventricular ejection fraction, LV end-diastolic volume, and grade of mitral regurgitation improved in all groups early after surgery; however, these variables in the restrictive group significantly deteriorated late after surgery (from 29 +/- 8 to 25 +/- 6 for LV ejection fraction; from 183 +/- 59 to 226 +/- 53 for left ventricular end-diastolic volume; and from 0.7 +/- 0.6 to 1.7 +/- 0.9 for mitral regurgitation grade; p < 0.05 for all).


CONCLUSIONS
In patients with LV systolic dysfunction undergoing SVR, preoperative restrictive LV diastolic filling pattern strongly related to higher mortality with aggravation of LV systolic function, mitral regurgitation grade, or LV remodeling. This might be attributable to deterioration of diastolic function induced by SVR.
Marui
Akira
A
Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan. marui@kuhp.kyoto-u.ac.jp
Nishina
Takeshi
T
Saji
Yoshiaki
Y
Yamazaki
Kazuhiro
K
Shimamoto
Takeshi
T
Ikeda
Tadashi
T
Sakata
Ryuzo
R
D000368:Aged; D000704:Analysis of Variance; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D002423:Cause of Death; D015331:Cohort Studies; D003971:Diastole / Q000502:physiology; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000401:mortality; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013318:Stroke Volume; D015996:Survival Rate; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D020257:Ventricular Remodeling / Q000502:physiology