Wall motion score index predicts mortality and functional result after surgical ventricular restoration for advanced ischemic heart failure☆

Abstract

Sufficient residual remote myocardium is necessary to recover from a SVR procedure and to translate the surgically induced morphological changes into a functional improvement. Preoperative WMSI is a surrogate measure of residual remote myocardial function and is a promising tool for better patient selection to improve results after SVR procedures for advanced ischemic heart failure.

Predictors of adverse events after surgical ventricular restoration for advanced ischaemic cardiomyopathy☆

“…This may correlate with the failure to identify severe LV dilatation or EF as risk factors for adverse late events following SVR [10]. Conversely, although WMSI has been reported to predict outcome after SVR [3], and may represent a more accurate surrogate of overall LV contractility, particularly of remote muscle, we failed to identify a predictive role of WMSI. Interestingly, WMSI constantly improved at all time points, possibly indicating a 'geometric benefit' of LV re-shaping following SVR, and very similar results have been recently reported in a series of patients who underwent SVR with implantation of a very narrow intraventricular patch [11].…”

“…[1] 41.2 AE 5.9 [1] 40.9 AE 6.9 [1] End-diastolic volume index (mlÁm À2 ) 9 4 . 9 AE 22.1 61.8 AE 15.7 [1] 65.3 AE 18.0 [1,2] 70.9 AE 22.6 [1][2][3] End-systolic volume index (mlÁm À2 ) 6 6 . 1 AE 17.6 37.9 AE 9.6 [1] 39.8 AE 12.3 [1] 42.7 AE 15.9 [1][2][3] Wall motion score index 2.25 AE 0.37 2.01 AE 0.29 [1] 1.91 AE 0.23 [1] 1.70 AE 0.41 [1][2][3] Sphericity index 0.73 AE 0.10 0.65 AE 0.12 [1] 0.67 AE 0.13 [1] 0.71 AE 0.16 [2,3] Mitral regurgitation Superscripts indicate statistically significant differences versus baseline [1] , discharge [2] and 12-month follow-up [3] .…”

“…The reduction of systolic function that follows myocardial infarction and chronic ischaemia determines progressive LV dilatation and loss of elliptical geometry, commonly referred to as LV remodelling. Surgical ventricular restoration (SVR) in patients with prior extensive anterior myocardial infarction has been widely performed with good results, usually as an adjunct to coronary artery bypass grafting (CABG), but the effectiveness of SVR is not clearly defined and data from randomised trials are scarce [1][2][3]. A classification of LV remodelling into three subtypes, namely LV aneurysm (type I), intermediate cardiomyopathy (II) and ischaemic dilated cardiomyopathy (III), has recently been proposed [4].…”

Management of mitral regurgitation during left ventricular reconstruction for ischemic heart failure

“…Patients were considered eligible for LV reconstructive surgery when they had LV dilatation following an antero-septal myocardial infarction with an echocardiographically derived Wall Motion Score Index (WMSI) ≤ 2.5, or with evidence of contractile reserve when WMSI exceeded 2.5, as described earlier [8]. Patients were attributed to an RMA and no-RMA group, depending on whether or not concomitant RMA had been performed.…”

Surgical Ventricular Restoration: Is There Any Difference in Outcome Between Anterior and Posterior Remodeling?

“…The fact that remote myocardium (especially the anteroseptal wall) presented with relatively preserved wall thickness in the posterior group could be a possible explanation for the favorable outcomes. Indeed, the systolic function of the remote myocardium has been demonstrated to be 1 of the major determinants of the residual LV systolic function after SVR and subsequent long-term outcome [16].…”