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Effect of revascularization on left ventricular remodeling in patients with heart failure from severe chronic
1Department of Cardiovascular Medicine, Northwick Park, Harrow, United Kingdom. nphcardiology@netscapeonline.co.uk
Insights
Revascularization improves left ventricular (LV) geometry and function in patients with severe systolic dysfunction and viable myocardium. Improved LV geometry predicts better long-term survival, independent of revascularization itself.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Cardiac Imaging
Background:
- Limited data exist on revascularization's impact on left ventricular (LV) geometry in severe systolic dysfunction with viable myocardium.
- Chronic ischemic heart disease can lead to severe LV dysfunction and impact cardiac remodeling.
Purpose of the Study:
- To investigate the effect of revascularization on LV geometry and long-term outcomes in patients with severe ischemic LV dysfunction and viable myocardium.
- To determine if improvements in LV geometry after revascularization are independent of functional improvements and predict survival.
Main Methods:
- Studied 70 patients with severe ischemic LV dysfunction (ejection fraction <0.35).
- Patients underwent either revascularization (n=36) or medical treatment (n=34).
- Evaluated changes in LV function and geometry at 21 months and long-term outcomes over 3.5 years.
Main Results:
- Patients with viable myocardium showed improved LV geometry (size and shape) and function post-revascularization.
- LV geometry improvements were independent of and incremental to functional gains.
- Reduced LV end-systolic volume was the sole predictor of survival in long-term follow-up.
Conclusions:
- Revascularization positively impacts LV geometry in select heart failure patients.
- Assessing LV geometry changes is crucial when evaluating revascularization efficacy in chronic ischemic heart disease.
- Improved LV geometry is linked to better LV systolic function and predicts long-term survival.
Abstract:
Few data exist regarding the effect of revascularization on left ventricular (LV) geometry in patients with severe LV systolic dysfunction and viable myocardium. We hypothesized that patients with chronic ischemic LV dysfunction but viable myocardium will have improved LV geometry after revascularization, which in turn will improve long-term outcome. Accordingly, 70 patients with severe ischemic LV dysfunction (LV ejection fraction <0.35) were studied at rest. They then either underwent revascularization (n = 36) or were treated medically (n = 34). Fifty-four patients had viable myocardium, and 16 did not. They were evaluated for change in LV function and geometry (size and shape) a mean of 21 months later. Further follow-up was performed for a mean of 3.5 years to determine outcome. Patients with viable myocardium had improvement not only in regional and global function, but also in LV geometry (shape and size), which was independent of and incremental to the improvement in function. On long-term follow-up, change in LV end-systolic volume was the only multivariate discriminator between 15 patients who died and 55 who did not, irrespective of whether they had undergone revascularization. Thus, measurement of the effect of revascularization of viable myocardium in chronic ischemic heart disease should not only include improvement in resting regional and global LV function, but also LV geometry. Improvement in LV geometry contributes to better LV systolic function, which in turn is the best predictor of survival after revascularization.