| Effects of surgical ventricular reconstruction on diastolic function at midterm follow-up. | |
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MedLine Citation:
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PMID: 20038481 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Limited data are available on the effects of surgical ventricular reconstruction on diastolic function. The aim of the present study was to evaluate changes in diastolic function induced by surgical ventricular reconstruction at 2 time intervals after surgery (discharge and follow-up) and to assess the impact of diastolic changes on clinical outcome. METHODS: A total of 129 patients (65 +/- 9 years, 14 women) underwent echocardiographic Doppler evaluation before surgical ventricular reconstruction, at discharge, and at follow-up (median 7 months). Patients with mitral regurgitation were excluded. Diastolic pattern was graded as follows: 0 (normal), 1 (abnormal relaxation), 2 (pseudo normalization), 3 (restrictive, reversible), and 4 (restrictive, irreversible). RESULTS: At follow-up, 28 (21.7%) of 129 patients showed a restrictive diastolic pattern (grade 3-4; group 1) and 101 did not (diastolic pattern grade 0-2; group 2). Preoperative and postoperative factors strongly associated with late diastolic restriction included sphericity index (higher in group 1), ventricular shape (nonaneurysmal shape more frequent in group 1), internal dimensions (greater in group 1), diastolic pattern (higher in group 1), ejection fraction (lower in group 1); left atrial dimensions (greater in group 1); mitral regurgitation rate (higher in group 1). At multivariate analysis the most powerful predictors of restriction were preoperative pseudonormalization of diastolic pattern (diastolic pattern 2) and septolateral dimensions (short axis). Overall, ejection fraction improved from 33% +/- 9% to 40% +/- 9% to 40% +/- 9%; P = .001; end-diastolic and end-systolic volumes decreased (112 +/- 41 to 73 +/- 21 to 88 +/- 28 mL/m(2), respectively; P = .001; and 77 +/- 38 to 44 +/- 17 to 52 +/- 24 mL/m(2), respectively; P = .001); New York Heart Association class improved (2.4 +/- 0.8 to 1.6 +/- 0.6; P = .001). CONCLUSIONS: Mild preoperative diastolic dysfunction (pseudonormalized pattern) and increased septolateral dimensions are independent predictors of diastolic restriction after surgical ventricular reconstruction. |
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Authors:
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Marisa Di Donato; Lorenzo Menicanti; Marco Ranucci; Serenella Castelvecchio; Carlo de Vincentiis; Josephal Salvia; Tammam Yussuf |
Publication Detail:
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Type: Journal Article Date: 2009-12-28 |
Journal Detail:
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Title: The Journal of thoracic and cardiovascular surgery Volume: 140 ISSN: 1097-685X ISO Abbreviation: J. Thorac. Cardiovasc. Surg. Publication Date: 2010 Aug |
Date Detail:
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Created Date: 2010-07-19 Completed Date: 2010-08-10 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0376343 Medline TA: J Thorac Cardiovasc Surg Country: United States |
Other Details:
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Languages: eng Pagination: 285-291.e1 Citation Subset: AIM; IM |
Copyright Information:
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Copyright 2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved. |
Affiliation:
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Department of Cardiac Surgery, IRCCS San Donato Hospital, Milan, Italy. marad@tin.it |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Cardiac Surgical Procedures* / adverse effects, mortality Cardiomyopathy, Dilated / mortality, physiopathology, surgery*, ultrasonography Chi-Square Distribution Diastole Echocardiography, Doppler Female Heart Ventricles / physiopathology, surgery*, ultrasonography Humans Kaplan-Meiers Estimate Logistic Models Male Middle Aged Myocardial Contraction* Retrospective Studies Risk Assessment Risk Factors Stroke Volume Time Factors Treatment Outcome Ventricular Dysfunction, Left / mortality, physiopathology, surgery*, ultrasonography Ventricular Function, Left* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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