Objective: Surgical ventricular restoration (SVR) surgery is increasingly being utilized, but there are limited data about the extent of myocardium viability that are required to predict degrees of improvement in left ventricular ( LV) function following SVR. The aim of this study was to determine whether the extent of scar is important in amount of recovery after SVR.
Methods: Magnetic resonance imaging is used to define LV function and the amount of scar tissue. A total of 72 consecutives patients were prospectively followed. Complete follow-up was available on 100% of patients. The clinical variables were tested using multivariate analysis. The amount of fibrosis was detemined by semi-quantitative method. Left ventricle was divided in 48 proportional slices. The total of fibrosis and the importance of the fibrosis distribuition in the lateral and inferior wall were tested. The association between scar score and absolute change in ejection fraction baseline and post-operative SVR follow-up was compared across tertiles
Results: Independent predictors of change of LV ejection fraction were: scar (p=0,001); mitral regurgitation (p=0,008), cardiogenic shock (p=0,02) and diabetes (p=0,01), time to operation (p=0,003)
Fibrosis area, scarred tissue, was divided in tertiles (I, small: 10 until 25%, n=22 patients II, moderate: 25 until 41%, n= 37 patients; III, larger: 41 until 56%, n=13 patients) and there was a statistical difference in the LV systolic volume between small and larger scar score tertile ( I versus III)(p=0,004) and ejection fraction (p=0,01).
Conclusions: The extension of amount of scar was a significant predictor of LV function recovery after SVR.