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Updated: Mar 18, 2026
Morphological and Functional Assessment of the Right Ventricle Using 3D Echocardiography
Published on: October 28, 2020
Ventricular volume and myocardial viability, evaluated using cardiac magnetic resonance imaging, affect long-term
Sachiko Yamazaki1, Kiyoshi Doi2, Satoshi Numata2
1Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan rockyyamazaki@yahoo.co.jp.
Insights
Surgical ventricular reconstruction (SVR) improves left ventricular (LV) function and volume. Patients with preoperative indexed LV end-systolic volume (LVESVI) between 100-130 ml/m² showed the best outcomes, highlighting the importance of cardiac MRI for patient selection.
Area of Science:
- Cardiovascular Surgery
- Cardiology
- Medical Imaging
Background:
- Ischaemic cardiomyopathy significantly impacts left ventricular (LV) function.
- Surgical ventricular reconstruction (SVR) is a therapeutic option for selected patients.
- Cardiac magnetic resonance imaging (MRI) aids in evaluating LV structure and function.
Purpose of the Study:
- To assess the outcomes of SVR in patients with ischaemic cardiomyopathy.
- To identify optimal candidates for SVR using preoperative cardiac MRI.
- To correlate preoperative LV parameters with midterm adverse cardiac events.
Main Methods:
- Retrospective analysis of 50 patients undergoing SVR with preoperative cardiac MRI.
- Evaluation of LV volume and scarring using cine and gadolinium-enhanced MRI.
- Stratification into groups based on preoperative indexed LV end-systolic volume (LVESVI) for risk factor analysis.
Main Results:
- Preoperative LVESVI was a significant predictor of major adverse cardiac events (MACEs).
- SVR led to significant reductions in LVESVI and improvements in LV ejection fraction (LVEF) post-procedure and at follow-up.
- Patients with LVESVI of 100-130 ml/m² demonstrated the most pronounced improvements in LVEF and LVESVI.
Conclusions:
- SVR effectively improves LV remodelling and function in ischaemic cardiomyopathy.
- Cardiac MRI is crucial for preoperative assessment and patient stratification for SVR.
- Patients with LVESVI between 100-130 ml/m² may represent an ideal candidate group for SVR.
Objectives:
We aimed to investigate the outcomes of surgical ventricular reconstruction (SVR) for ischaemic cardiomyopathy and to identify ideal candidates for this procedure using cardiac magnetic resonance imaging (MRI) studies.
Methods:
We retrospectively examined 50 patients who underwent SVR and were preoperatively evaluated using cardiac MRI from 2004 to 2014. Cine MRI and gadolinium-enhanced MRI were performed to evaluate left ventricular (LV) volume and scarring. The midterm (median, 2.5 years) risk factors of cardiac death or major adverse cardiac events (MACEs) were analysed. Patients were divided into three groups-those with preoperative indexed LV end-systolic volume (LVESVI) of ≤100 ml/m2 (Group 1), those with LVESVI of >100 and ≤130 ml/m2 (Group 2) and those with LVESVI of >130 ml/m2 (Group 3)-and examined.
Results:
In total, 17 patients exhibited MACEs at follow-up. Kaplan-Meier analysis showed that the 5-year rate of freedom from MACEs was 66%. The Cox hazard model indicated that preoperative LVESVI was the only significant predictor for MACEs (P = 0.006; hazard ratio, 1.02; 95% confidence interval, 1.01-1.04). Moreover, a significant reduction in LVESVI and an increase in LV ejection fraction (LVEF) were observed early after SVR (preoperative versus postoperative: LVESVI, 110 ± 44 vs 68 ± 28 ml/m2, P < 0.001; LVEF, 24.3 ± 10.3 vs 32.0 ± 10.4%, P < 0.001) and at follow-up (LVESVI, 61 ± 28 ml/m2, P < 0.001; LVEF, 36.5 ± 11.5%, P < 0.001). Although no difference was observed between the groups at follow-up, LVEF and LVESVI primarily improved in Group 2. LVEF improvement was significantly greater in Group 2 than in Group 1 (%increase in LVEF: Group 1, 6%; Group 2, 18%; P = 0.008). In patients with a preoperative LVESVI of >130 ml/m2, the number of non-viable segments was a significant risk factor for MACEs.
Conclusions:
Patients with preoperative LVESVI ranging from 100 to 130 ml/m2 had fairly better outcomes, and the percentage improvement in LVEF and the percentage reduction in LVESVI were more pronounced in these patients. Hence, accurate preoperative assessments of LV volume and viability testing using cardiac MRI studies are essential for better stratification of the SVR procedure.
