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Significance of left ventricular diastolic function on outcomes after surgical ventricular restoration.
Ann Thorac Surg 2010; 89(5):1524-31AT

Abstract

BACKGROUND

Surgical ventricular restoration (SVR) has been introduced to restore the dilated left ventricular (LV) chamber and improve LV systolic function; however, SVR has also been reported to detrimentally affect LV diastolic properties. We sought to investigate the impact of preoperative LV diastolic function on outcomes after SVR in patients with heart failure.

METHODS

Sixty-seven patients (60 +/- 14 years) with LV systolic dysfunction (LV ejection fraction, 0.27 +/- 0.10) underwent SVR. They were evaluated by echocardiography preoperatively, and early (<or=1 month) and late (mean, 3.4 years) after surgery. Patients were divided into three groups according to the preoperative diastolic filling patterns of transmitral flow (impaired relaxation, pseudonormal, and restrictive filling patterns).

RESULTS

Patients in the restrictive group showed far greater cardiovascular mortality than the other two groups (p < 0.0001). The multivariate analysis showed that preoperative restrictive filling pattern was a predominant predictor for adjusted cardiovascular death (p = 0.023; hazard ratio = 3.0). Left ventricular ejection fraction, LV end-diastolic volume, and grade of mitral regurgitation improved in all groups early after surgery; however, these variables in the restrictive group significantly deteriorated late after surgery (from 29 +/- 8 to 25 +/- 6 for LV ejection fraction; from 183 +/- 59 to 226 +/- 53 for left ventricular end-diastolic volume; and from 0.7 +/- 0.6 to 1.7 +/- 0.9 for mitral regurgitation grade; p < 0.05 for all).

CONCLUSIONS

In patients with LV systolic dysfunction undergoing SVR, preoperative restrictive LV diastolic filling pattern strongly related to higher mortality with aggravation of LV systolic function, mitral regurgitation grade, or LV remodeling. This might be attributable to deterioration of diastolic function induced by SVR.

Authors+Show Affiliations

Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan. marui@kuhp.kyoto-u.ac.jpNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20417772

Citation

Marui, Akira, et al. "Significance of Left Ventricular Diastolic Function On Outcomes After Surgical Ventricular Restoration." The Annals of Thoracic Surgery, vol. 89, no. 5, 2010, pp. 1524-31.
Marui A, Nishina T, Saji Y, et al. Significance of left ventricular diastolic function on outcomes after surgical ventricular restoration. Ann Thorac Surg. 2010;89(5):1524-31.
Marui, A., Nishina, T., Saji, Y., Yamazaki, K., Shimamoto, T., Ikeda, T., & Sakata, R. (2010). Significance of left ventricular diastolic function on outcomes after surgical ventricular restoration. The Annals of Thoracic Surgery, 89(5), pp. 1524-31. doi:10.1016/j.athoracsur.2010.01.067.
Marui A, et al. Significance of Left Ventricular Diastolic Function On Outcomes After Surgical Ventricular Restoration. Ann Thorac Surg. 2010;89(5):1524-31. PubMed PMID: 20417772.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Significance of left ventricular diastolic function on outcomes after surgical ventricular restoration. AU - Marui,Akira, AU - Nishina,Takeshi, AU - Saji,Yoshiaki, AU - Yamazaki,Kazuhiro, AU - Shimamoto,Takeshi, AU - Ikeda,Tadashi, AU - Sakata,Ryuzo, PY - 2009/01/28/received PY - 2010/01/25/revised PY - 2010/01/28/accepted PY - 2010/4/27/entrez PY - 2010/4/27/pubmed PY - 2010/6/4/medline SP - 1524 EP - 31 JF - The Annals of thoracic surgery JO - Ann. Thorac. Surg. VL - 89 IS - 5 N2 - BACKGROUND: Surgical ventricular restoration (SVR) has been introduced to restore the dilated left ventricular (LV) chamber and improve LV systolic function; however, SVR has also been reported to detrimentally affect LV diastolic properties. We sought to investigate the impact of preoperative LV diastolic function on outcomes after SVR in patients with heart failure. METHODS: Sixty-seven patients (60 +/- 14 years) with LV systolic dysfunction (LV ejection fraction, 0.27 +/- 0.10) underwent SVR. They were evaluated by echocardiography preoperatively, and early (<or=1 month) and late (mean, 3.4 years) after surgery. Patients were divided into three groups according to the preoperative diastolic filling patterns of transmitral flow (impaired relaxation, pseudonormal, and restrictive filling patterns). RESULTS: Patients in the restrictive group showed far greater cardiovascular mortality than the other two groups (p < 0.0001). The multivariate analysis showed that preoperative restrictive filling pattern was a predominant predictor for adjusted cardiovascular death (p = 0.023; hazard ratio = 3.0). Left ventricular ejection fraction, LV end-diastolic volume, and grade of mitral regurgitation improved in all groups early after surgery; however, these variables in the restrictive group significantly deteriorated late after surgery (from 29 +/- 8 to 25 +/- 6 for LV ejection fraction; from 183 +/- 59 to 226 +/- 53 for left ventricular end-diastolic volume; and from 0.7 +/- 0.6 to 1.7 +/- 0.9 for mitral regurgitation grade; p < 0.05 for all). CONCLUSIONS: In patients with LV systolic dysfunction undergoing SVR, preoperative restrictive LV diastolic filling pattern strongly related to higher mortality with aggravation of LV systolic function, mitral regurgitation grade, or LV remodeling. This might be attributable to deterioration of diastolic function induced by SVR. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/20417772/Significance_of_left_ventricular_diastolic_function_on_outcomes_after_surgical_ventricular_restoration_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(10)00246-8 DB - PRIME DP - Unbound Medicine ER -