Background. Experimental studies and theoretical considerations suggest that reduction of left ventricle (LV) stroke volume (SV) following Surgical Ventricular Restoration (SVR) is a consequence of diastolic dysfunction. Aim. To analyze changes in SV following SVR and assess if SV reduction is related to diastolic dysfunction. Patients. 134 consecutive patients submitted to SVR for symptoms of HF and/or angina. Patients with mitral regurgitation were excluded.
Results. SV improved in 43 patients (54 ± 13 to 60 ± 15 ml; p 0.0001)-G1- and decreased in 91 patients (69 ± 19 to 48 ± 13 ml, p 0.0001)-G2-. The greater EDV reduction, the greater SV reduction (r = 0.609) and the greater EF improvement (r = 0.402)(Graph). Preoperatively, EF and SV were lower in G1 (31 ± 8 vs 35 ± 8%, p 0.002 and 54 ± 13 vs 69 ± 19 ml, respectively); no differences in LV volumes and Diastolic Filling Pattern (DP). Post surgery G2 shows smaller EDV and ESV and lower SV. DP significantly increased in G1 (from 1.42 ± 0.8 to 1.7 ± 0.7, p 0.01) and was higher than in G2, after surgery (p 0.008). NYHA class at FUP improved (2.4 ± 0.6 to 1.6 ± 0.6 in G1 and 2.4 ± 0.7 to 1.7 ± 0.6 in G2, p 0.001)
Post-operative data
Conclusions. Post-SVR stroke volume reduction is not related to diastolic dysfunction; paradoxically, diastolic function is more impaired in patients with SV improvement and larger residual volumes.
Volume reduction rate by surgical ventricular restoration determines late outcome in ischaemic cardiomyopathy
