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Objectives: We hypothesized that remote myocardial scar which could not be affected by surgery would have negative impact on the postoperative left ventricular function after surgical ventricular restoration (SVR) in ischemic cardiomyopathy.
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Koji Takeda1, Goro Matsumiya1, Hajime Matsue1, Koichi Toda1, Seiki Hamada2, Yoshiki Sawa1.
1Cardiovascular surgery, Osaka university graduate school of medicine, Suita, Japan, 2Radiology, Osaka university graduate school of medicine, Suita, Japan.
Methods: In 10 patients who underwent SVR, late gadolinium enhancement magnetic resonance imaging (LGE-MRI) was obtained before and after surgery. Remote myocardial scar from base to highly mid left ventricular images was quantified on the basis of the amount of hyperenhancement on LGE-MRI.
Results: Percent fibrosis varied from 0 to 29.9% (mean ± SD; 11.2 ± 8.6%). Patients with greater amount of remote myocardial fibrosis (%fibrosis >10%) showed significantly progressive left ventricular remodeling preoperatively; larger left ventricular volume (p=.01), decreased ejection fraction (p=.03), and greater degree of mitral regurgitation (p=.05). Postoperative left ventricular function is significantly worse in patient with greater remote myocardial fibrosis. Degree of % fibrosis linearly correlated with postoperative decreased ejection fraction (R2 = 0.65, p=.004) and greater end-systolic left ventricular volume index (R2 = 0.42, p=.04).
Conclusion: Amount of remote myocardial scar affected preoperative left ventricular remodeling and eventually postoperative left ventricular function after SVR. Preoperative assessment of remote myocardial status on LGE-MRI predicts surgical outcomes in patients undergoing SVR.
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