title: Slope in preload recruitable stroke work relationship predicts survival after left ventriculoplasty and mitral repair in patients with idiopathic cardiomyopathy.
abstract: BACKGROUND
  Left ventriculoplasty (LVP) and mitral valve plasty (MVP) are sometimes effective for patients with idiopathic dilated cardiomyopathy (DCM) who are not eligible for heart transplantation. Strict patient selection is warranted for these controversial procedures.
  
  
  RESULTS
  The subjects were 18 patients with idiopathic DCM and mitral regurgitation who had not been indicated for heart transplantation due to either older age or patient refusal, and who underwent LVP and MVP. Their mean age was 57±14 years and 50% were dependent on catecholamine infusion. The preload recruitable stroke work (PRSW) relationship and its slope (Mw) were estimated by a single-beat technique using transthoracic echocardiography. There were one 30-day mortality and six (33%) hospital deaths due to heart failure. The one-year survival rate was 50%. Left ventricular end-diastolic dimension (LVDd) decreased from 77±11 to 68±11mm (p=0.001) whereas the ejection fraction did not change. Preoperative Mw was significantly higher in one-year survivors than that in non-survivors (54±17ergcm(-3)10(3) vs. 31±10ergcm(-3)10(3), p=0.005). Preoperative LVDd was not different between the groups. The cut-off value of 42ergcm(-3)10(3) for Mw predicted one-year survival with high sensitivity (100%) and specificity (77%).
  
  
  CONCLUSIONS
  Mw, the slope in the PRSW relationship, may predict survival after LVP and MVP in patients with idiopathic DCM.
authors: Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Yasushige
authors: Y
authors: Shingu
authors: Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Suguru
authors: S
authors: Kubota
authors: Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Satoru
authors: S
authors: Wakasa
authors: Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Tomonori
authors: T
authors: Ooka
authors: Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Hiroki
authors: H
authors: Kato
authors: Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Tsuyoshi
authors: T
authors: Tachibana
authors: Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan. Electronic address: ymatsui@med.hokudai.ac.jp.
authors: Yoshiro
authors: Y
authors: Matsui
mesh_terms: D000328:Adult; D000368:Aged; D002302:Cardiac Output / Q000502:physiology*; D002311:Cardiomyopathy, Dilated / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000401:mortality; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality*; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058386:Mitral Valve Annuloplasty / Q000401:mortality*; D008944:Mitral Valve Insufficiency / Q000503:physiopathology / Q000601:surgery; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D015996:Survival Rate
keywords: Cardiomyopathy; Mitral regurgitation; Surgery