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Impact of left ventricular function on immediate and long-term outcomes after pericardiectomy in constrictive
Jong-Won Ha1, Jae K Oh, Hartzell V Schaff
1Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn 55905, USA.
Insights
Abnormal left ventricular contractility and relaxation in constrictive pericarditis patients predict worse outcomes after pericardiectomy, indicating these non-ejection phase indexes are crucial for prognosis.
Area of Science:
- Cardiology
- Cardiac Surgery
- Physiology
Background:
- Constrictive pericarditis often presents with normal ejection fraction, yet outcomes after pericardiectomy vary.
- Predicting postoperative prognosis in these patients remains challenging.
Purpose of the Study:
- To investigate if non-ejection phase indexes of left ventricular function, specifically peak positive dP/dt and tau, can predict outcomes after pericardiectomy for constrictive pericarditis.
- To correlate preoperative cardiac catheterization findings with surgical results.
Main Methods:
- Analysis of 40 patients with constrictive pericarditis undergoing pericardiectomy.
- Preoperative cardiac catheterization to measure left ventricular pressures and derive peak positive dP/dt and tau.
- Classification of patients into three groups based on preoperative +dP/dt and tau values.
Main Results:
- Patients with abnormal +dP/dt and tau (Group 1) had lower ejection fraction and higher end-diastolic pressures.
- Group 1 required more postoperative inotropic support and had significantly higher operative mortality and lower long-term survival.
- Abnormalities in non-ejection phase indexes strongly correlated with adverse surgical outcomes.
Conclusions:
- Preoperative assessment of left ventricular contractility and relaxation using non-ejection phase indexes is vital for predicting outcomes in constrictive pericarditis patients undergoing pericardiectomy.
- Abnormal +dP/dt and tau identify patients at higher risk for operative mortality and poor long-term survival.
Objective:
Most patients with constrictive pericarditis have normal measures of left ventricular function when assessed by the ejection phase index of ejection fraction, yet there is a wide spectrum of outcome after pericardiectomy. We hypothesized that parameters of non-ejection indexes of cardiac function (+dP/dt and tau) may predict postoperative prognosis.
Methods:
The immediate and long-term outcomes of pericardiectomy were analyzed in 40 patients (30 male, mean age 62 years) with surgically confirmed constrictive pericarditis who underwent preoperative cardiac catheterization using high-fidelity micromanometer pressures. Left ventricular pressures were digitized at 5-msec intervals during end expiration, from which peak positive dp/dt and tau measurements were obtained. Patients were classified into 3 groups: Group 1 (n = 13) included those with abnormal +dP/dt and tau (defined as +dP/dt < 1200 mm Hg/s, tau > 50 msec); group 2 (n = 11) included those with either abnormal +dP/dt or tau; and group 3 (n = 16) included those with normal +dP/dt and tau.
Results:
There were no significant differences of gender, New York Heart Association class, duration of symptoms, and underlying cause among the 3 groups. Group 1 patients had lower preoperative ejection fraction and higher left and right ventricular end-diastolic pressures. Postoperative inotropic support was more frequently needed in group 1, and postoperative mortality was higher in group 1 than in groups 2 and 3. All postoperative deaths but 1 were in group 1. The median postoperative follow-up was 2.4 years. The postoperative long-term survival of group 1 was significantly lower compared with that of groups 2 and 3.
Conclusion:
In patients with constrictive pericarditis undergoing pericardiectomy, those with abnormal left ventricular contractility and relaxation properties assessed by cardiac catheterization before surgery incur higher operative mortality and poor long-term outcome after surgery.
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