Left Ventricular Volume Predicts Postoperative Course in Patients With Ischemic Cardiomyopathy

Yamaguchi, Atsushi; Ichihara, T.; Adachi, Hideo; Murata, Shigeo; Kamio, H; Okada, Masahiko; Tsuboi, Junichi

doi:10.1016/s0003-4975(97)01155-7

Cited by 193 publications

(102 citation statements)

References 16 publications

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“…The patients with a lower LV end-systolic volume had a higher likelihood of improvement in LV ejection fraction after revascularization. These observations extend the results from Yamaguchi et al 5 and suggest that extensive remodeling of the LV may indeed prevent improvement in LV ejection fraction after revascularization, despite the presence of substantial (Ն25% of the LV) viable myocardium.…”

Section: Discussionsupporting

confidence: 89%

“…4 The failure of viable myocardium to recover in function after revascularization may be related to various issues. One important issue, suggested recently by Yamaguchi et al, 5 is the presence of extensive LV remodeling. The authors evaluated 41 patients undergoing surgical revascularization and demonstrated that 10 of 16 (63%) patients with extensive remodeling had heart failure after surgery and that in these patients, the LV ejection fraction did not improve after revascularization (24Ϯ6% versus 25Ϯ6%, NS).…”

Section: Discussionmentioning

confidence: 96%

“…It has been suggested that a severely dilated LV (extensive remodeling) may not allow functional recovery after revascularization. 5,6 Currently, not much information is available on this issue. In particular, the relation between LV size and viability, in some cases, and improvement of function after revascularization, in other cases, is not known.…”

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confidence: 99%

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Extensive Left Ventricular Remodeling Does Not Allow Viable Myocardium to Improve in Left Ventricular Ejection Fraction After Revascularization and Is Associated With Worse Long-Term Prognosis

et al. 2004

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Background-Extensive left ventricular (LV) remodeling may not allow functional recovery after revascularization, despite the presence of viable myocardium. Methods and Results-Seventy-nine consecutive patients with ischemic cardiomyopathy (left ventricle ejection fraction[LVEF] 29Ϯ7%) underwent surgical revascularization. Before revascularization, viability was assessed by metabolic imaging with F18-fluorodeoxyglucose and SPECT. LV volumes and LVEF were assessed by resting echocardiography. LVEF was re-assessed by echocardiography 8 to 12 months after revascularization. Three-year clinical follow-up (events: cardiac death, infarction, and hospitalization for heart failure) was also obtained. Forty-nine patients had substantial viability; 5 died before re-assessment of LVEF. Of the remaining 44 patients, 24 improved Ն5% in LVEF after revascularization, whereas 20 did not improve in LVEF. LV end-systolic volume was the only parameter that was significantly different between the groups (109Ϯ46 mL for the improvers versus 141Ϯ31 mL for the nonimprovers; PϽ0.05). The change in LVEF after revascularization was linearly related to the baseline LV end-systolic volume, with a higher LV end-systolic volume associated with a low likelihood of improvement in LVEF after revascularization. During the 3-year follow-up, the highest event-rate (67%) was observed in patients without viable myocardium with a large LV size, whereas the lowest event rate (5%) was observed in patients with viable myocardium and a small LV size. Intermediate event rates were observed in patients with viable myocardium and a large LV size (38%), and in patients without viable myocardium and a small LV size (24%). Conclusion-Extensive

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 96%

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Extensive Left Ventricular Remodeling Does Not Allow Viable Myocardium to Improve in Left Ventricular Ejection Fraction After Revascularization and Is Associated With Worse Long-Term Prognosis

et al. 2004

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“…There are doubts as to the benefit of revascularization when ventricular volumes are increased, and the results are not as satisfactory as revascularization in patients without an enlarged left ventricle [6][7][8] .…”

Section: Myocardial Revascularizationmentioning

confidence: 99%

Tratamento cirúrgico de pacientes com insuficiência cardíaca: revascularização miocárdica, reconstrução ventricular, cirurgia valvar mitral

Buffolo¹

2007

Arq. Bras. Cardiol.

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Heart failure, a final outcome of different cardiomyopathies is currently the most serious problem in the field of cardiology and public health.Despite the extraordinary progress made over the last two decades regarding the understanding of the deeper mechanisms of ventricular failure as an endocrine-metabolic syndrome, it is the major cause of death in the adult population.This justifies the use of polypharmacy with five or more active principles with a view to neutralizing different stages of the adrenergic stimulation cascade.The clinical application of these active principles fascinates professionals, leading them to attach great importance to the heart failure syndrome, so much so that they sometimes accept the etiology of the disease without further questioning and, beyond that, fail to identify causes of heart failure that could be removed.The identification of the causal mechanism of the disease and its removal or neutralization translates into a significant impact on the progression of the disease. This is the case of ischemic myocardiopathies, tachymyopathies, deposit and metabolic diseases and others.With the emergence of important and recent concepts on ventricular dynamics under the light of the double helix helicoidal mechanism and the acknowledgement of the harmful effects of ventricular sphericity, it is necessary to approach heart failure from a mechanicist point of view that is not opposed to the endocrine-metabolic concepts, but allows the expectation of a better management of this syndrome.Among the possibilities of surgical intervention in these situations, we will briefly discuss the revascularization of ischemic myocardium, ventricular reconstruction and the repair of secondary mitral insufficiency. Myocardial revascularizationMyocardial ischemic dysfunction can be reversed by surgical treatment, in sharp contrast with clinical management alone, as demonstrated by several studies; it constitutes a major criterion for surgery indication 1-5 .More recently, the Ephesus and Valiant studies, with cutoff values for ejection fraction between 0.35 and 0.40 have proved the advantages of surgical revascularization over clinical management in the medium to long term.It is worthy of notice that with the assessment of ischemia using scintigraphy, stress-echo test and more recently nuclear magnetic resonance imaging, the results are predictable to a high degree, whereas the statement of absence of ischemia, even if a pet scan is conducted, is subject to an error risk of approximately 20%.It is therefore difficult to deny the indication of revascularization in patients with poor ventricular performance when there are approachable distal coronary beds.There are doubts as to the benefit of revascularization when ventricular volumes are increased, and the results are not as satisfactory as revascularization in patients without an enlarged left ventricle 6-8 .These observations constitute the basis for the proposal of associating some type of ventricular reconstruction with myocardial revascularization, and...

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“…It has been reported that the patients with ICM showed poor prognosis even after complete revascularization. 3,4) As the normal elliptical shape transforms to a spherical shape after remodeling, global systolic function worsens. In addition, the prognosis becomes extremely poor after the occurrence of functional mitral regurgitation (MR).…”

Section: Introductionmentioning

confidence: 99%

Strategy of Treatment for Ischemic Cardiomyopathy

et al. 2013

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Left Ventricular Volume Predicts Postoperative Course in Patients With Ischemic Cardiomyopathy

Cited by 193 publications

References 16 publications

Extensive Left Ventricular Remodeling Does Not Allow Viable Myocardium to Improve in Left Ventricular Ejection Fraction After Revascularization and Is Associated With Worse Long-Term Prognosis

Extensive Left Ventricular Remodeling Does Not Allow Viable Myocardium to Improve in Left Ventricular Ejection Fraction After Revascularization and Is Associated With Worse Long-Term Prognosis

Tratamento cirúrgico de pacientes com insuficiência cardíaca: revascularização miocárdica, reconstrução ventricular, cirurgia valvar mitral

Strategy of Treatment for Ischemic Cardiomyopathy

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