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Long-term outcomes of surgical ventricular reconstruction: Insight from cardiac magnetic resonance
Gianluigi Guida1, Serenella Castelvecchio2, Giandomenico Disabato1
1Cardiology University Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; Multimodality imaging Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
Insights
Surgical ventricular reconstruction (SVR) improves symptoms and left ventricular (LV) function in ischemic heart failure (HF) patients. Long-term survival is predicted by clinical factors and cardiac magnetic resonance imaging (CMR) parameters, including the LGE/LVEDVi ratio.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Imaging
Background:
- Ischemic heart failure (HF) significantly impacts patient morbidity and mortality.
- Surgical ventricular reconstruction (SVR) is a therapeutic option for selected patients with severe left ventricular (LV) dysfunction.
- Evaluating outcomes and predictors of survival after SVR is crucial for optimizing patient management.
Purpose of the Study:
- To assess clinical and cardiac magnetic resonance (CMR) outcomes following SVR in patients with ischemic HF.
- To identify independent predictors of long-term all-cause mortality after SVR.
Main Methods:
- A cohort of 126 patients with severe LV systolic dysfunction and symptomatic HF underwent SVR.
- Cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) was performed pre- and post-surgery.
- Cox regression analysis was employed to determine predictors of mortality.
Main Results:
- SVR led to significant improvements in NYHA class and LV ejection fraction (LVEF) at 6 months.
- The ratio of LGE to LV end-diastolic volume index (LGE/LVEDVi) was the only CMR parameter associated with mortality.
- Independent predictors of all-cause mortality included age, NYHA class III, moderate-to-severe mitral regurgitation, pulmonary artery systolic pressure (PASP), and LGE/LVEDVi ratio.
Conclusions:
- SVR effectively improves symptoms and LV function in patients with ischemic HF.
- Clinical variables and the LGE/LVEDVi ratio derived from CMR are significant predictors of long-term survival.
Objectives:
Surgical ventricular reconstruction (SVR) is used to treat selected patients with ischemic heart failure (HF). We evaluated clinical and cardiac magnetic resonance (CMR) outcomes after SVR and identified predictors of long-term survival in one of the largest reported SVR series.
Methods:
126 patients with severe left ventricular (LV) systolic dysfunction and symptomatic HF underwent SVR at a single center. All patients underwent CMR with late gadolinium enhancement (LGE) before and six months after surgery. Cox regression was used to identify predictors of all-cause mortality.
Results:
All patients had a previous myocardial infarction and symptomatic HF. At baseline, 61 patients (48 %) were in NYHA III, with a median NT-proBNP of 1464.5 pg/mL [707.0-2650]. Median LV end-diastolic (LVEDVi) and end-systolic volume index (LVESVi) were 129.7 and 91.2 mL/m2, respectively; mean LV ejection fraction (LVEF) was 27.9 % ± 9.2. Moderate-to-severe mitral regurgitation (MR) was present in 50 % of the patients. At 6-month, NYHA class III prevalence dropped from 49 % to 8 % (p = 0.001), and LVEF improved to 39.3 % (p < 0.001). Among CMR parameters, only LGE/LVEDVi was associated with mortality. Over a median follow-up of 6.4 years, age (HR 1.089 [1.013-1.170]), NYHA class III (HR 3.231 [1.043-10.009]), moderate-to-severe MR (HR 4.252 [1.259-14.363]), pulmonary artery systolic pressure (PASP; HR 1.034 [1.001-1.069]), and LGE/LVEDVi ratio (HR 0.017 [0.000-0.783]) were independent predictors of all-cause death.
Conclusions:
In patients with ischemic HF, symptoms and LV function improved after SVR. Long-term survival was predicted by clinical and imaging variables, including the new LGE/LVEDVi.
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