Document Detail


Effects of surgical ventricular reconstruction on diastolic function at midterm follow-up.
MedLine Citation:
PMID:  20038481     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Marisa Di Donato; Lorenzo Menicanti; Marco Ranucci; Serenella Castelvecchio; Carlo de Vincentiis; Josephal Salvia; Tammam Yussuf
Publication Detail:
Type:  Journal Article     Date:  2009-12-28
Journal Detail:
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:
Created Date:  2010-07-19     Completed Date:  2010-08-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  285-291.e1     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
Department of Cardiac Surgery, IRCCS San Donato Hospital, Milan, Italy. marad@tin.it
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MeSH Terms
Descriptor/Qualifier:
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*

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