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Left atrial function and work after surgical ventricular restoration in postmyocardial infarction heart failure

Petros S Dardas1, Antonis A Pitsis, Nikos E Mezilis

  • 1Department of Cardiology and Cardiothoracic Surgery, Thessaloniki Heart Institute, St Luke Hospital, Thessaloniki, Greece.

Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography
|April 4, 2008
PubMed

Insights

Surgical ventricular restoration improved left atrial function in heart failure patients only when left ventricular diastolic function also improved. This highlights the importance of diastolic function for atrial performance post-surgery.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Physiology
  • Heart Failure Management

Background:

  • Extensive anterior myocardial infarction often leads to left ventricular (LV) dilatation and congestive heart failure.
  • Surgical ventricular restoration (SVR) is a procedure aimed at improving LV geometry and function in these patients.
  • The impact of SVR on left atrial (LA) performance and LV diastolic function requires further investigation.

Purpose of the Study:

  • To evaluate the effect of SVR on LA performance and LV diastolic function.
  • To identify predictors of improved LA function following SVR in heart failure patients.

Main Methods:

  • Prospective study of 17 consecutive patients undergoing SVR and coronary artery bypass grafting.
  • Assessment of LA volumes, LA ejection fraction (LAEF), and peak LA kinetic energy (LAKE).
  • Evaluation of LV diastolic filling patterns pre- and post-operatively (1-year follow-up).

Main Results:

  • LA size and volumes remained unchanged 1 year post-SVR.
  • Two groups emerged: one with increased LAEF and LAKE, another with decreased values.
  • Significant differences in LV diastolic filling patterns were observed between groups; LA function improved only in patients with better diastolic filling.

Conclusions:

  • SVR improves clinical status and LV systolic function in heart failure patients with LV dilatation post-myocardial infarction.
  • Improvement in LA function after SVR is contingent upon concurrent improvement in LV diastolic function.
  • LV diastolic function is a critical determinant of LA performance following SVR for ischemic cardiomyopathy.
Abstract

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