title: Effects of surgical ventricular reconstruction and mitral complex reconstruction on cardiac oxidative metabolism and efficiency in nonischemic and ischemic dilated cardiomyopathy.
abstract: OBJECTIVE
  The aim of this study was to investigate the effects of surgical ventricular reconstruction (SVR) on cardiac efficiency as a surrogate marker for cardiac function and oxidative metabolism in patients with severe heart failure.
  
  
  BACKGROUND
  Our new integrated overlapping left ventriculoplasty, modified SVR, combined with mitral complex reconstruction, reduce left ventricular (LV) volume associated with improvement of symptoms of heart failure.
  
  
  METHODS
  Twelve consecutive patients with end-stage heart failure due to nonischemic dilated cardiomyopathy (DCM) (n = 6) and ischemic dilated cardiomyopathy (ICM) (n = 6) who underwent SVR were studied. Myocardial oxidative metabolism per gram of tissue was estimated by monoexponential clearance of (11)C-acetate positron emission tomography (K(mono)). Forward stroke volume at the LV outflow tract was measured by echocardiography. Cardiac efficiency was estimated by the ratio of external work (stroke volume at the LV outflow tract index × systolic blood pressure × heart rate) to K(mono) before and 1 month after SVR.
  
  
  RESULTS
  After SVR, medians of New York Heart Association functional class significantly improved from 3 to 1.5 (p < 0.01) in both DCM and ICM patients. End-systolic and end-diastolic volume and LV mass significantly decreased in both groups. Stroke volume at the LV outflow tract increased from 43 ± 8 ml to 52 ± 11 ml (p = 0.028) in DCM patients, but not in ICM patients (49 ± 21 ml to 59 ± 26 ml, p = 0.12). K(mono) × LV mass, as an index of global LV oxidative metabolism, decreased in DCM patients (13.6 ± 1.9 g/min vs. 8.6 ± 1.5 g/min, p = 0.03) and ICM patients (12.0 ± 3.4 g/min vs. 9.2 ± 1.0 g/min, p = 0.06). As a result, cardiac efficiency increased in all patients with DCM (3.34 ± 0.46 × 10E6 vs. 4.74 ± 0.88 × 10E6 mm Hg·ml·min/m(2), p = 0.03) and in 5 of 6 patients with ICM (4.54 ± 1.66 × 10E6 vs. 5.99 ± 2.11 × 10E6 mm Hg·ml·min/m(2), p = 0.12).
  
  
  CONCLUSIONS
  Combined surgery with SVR and mitral complex reconstruction reduced LV volume in association with improvement of cardiac efficiency in patients with severe heart failure.
authors.affiliation: Department of Cardiovascular Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Sugiki
authors.forename: Masanao
authors.initials: M
authors.lastname: Naya
authors.forename: Osamu
authors.initials: O
authors.lastname: Manabe
authors.forename: Satoru
authors.initials: S
authors.lastname: Wakasa
authors.forename: Suguru
authors.initials: S
authors.lastname: Kubota
authors.forename: Satoru
authors.initials: S
authors.lastname: Chiba
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Iwano
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamada
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Yoshinaga
authors.forename: Nagara
authors.initials: N
authors.lastname: Tamaki
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tsutsui
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Matsui
mesh_terms: D000085:Acetates / Q000378:metabolism; D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D018618:Echocardiography, Doppler, Color; D018619:Echocardiography, Doppler, Pulsed; D004734:Energy Metabolism; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D017202:Myocardial Ischemia / Q000150:complications*; D009206:Myocardium / Q000378:metabolism*; D010084:Oxidation-Reduction; D049268:Positron-Emission Tomography; D020127:Recovery of Function; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
chemical_list: D000085:Acetates