Acute and short-term effects of partial left ventriculectomy in dilated cardiomyopathy: assessment by pressure-volume loops.

Abstract

OBJECTIVES:

The aim of this study was to evaluate the short-term effects of partial left ventriculectomy (PLV) on left ventricular (LV) pressure-volume (P-V) loops, wall stress, and the synchrony of LV segmental volume motions in patients with dilated cardiomyopathy.

BACKGROUND:

Surgical LV volume reduction is under investigation as an alternative for, or bridge to, heart transplantation for patients with end-stage dilated cardiomyopathy.

METHODS:

We measured P-V loops in eight patients with dilated cardiomyopathy before, during and two to five days after PLV. The conductance catheter technique was used to measure LV volume instantaneously.

RESULTS:

The PLV reduced end-diastolic volume (EDV) acutely from 141+/-27 to 68+/-16 ml/m2 (p < 0.001) and to 65+/-6 ml/m2 (p < 0.001) at two to five days postoperation (post-op). Cardiac index (CI) increased from 1.5+/-0.5 to 2.6+/-0.6 l/min/m2 (p < 0.002) and was 1.8+/-0.3 l/min/m2 (NS) at two to five days post-op. The LV ejection fraction (EF) increased from 15+/-8% to 35+/-6% (p < 0.001) and to 26+/-3% (p < 0.003) at two to five days post-op. Tau decreased from 54+/-8 to 38+/-6 ms (p < 0.05) and was 38+/-5 ms (NS) at two to five days post-op. Peak wall stress decreased from 254+/-85 to 157+/-49 mm Hg (p < 0.001) and to 184+/-40 mm Hg (p < 0.003) two to five days post-op. The synchrony of LV segmental volume changes increased from 68+/-6% before PLV to 80+/-7% after surgery (p < 0.01) and was 73+/-4% (NS) at two to five days post-op. The LV synchrony index and CI showed a significant (p < 0.0001) correlation.

CONCLUSIONS:

The acute decrease in LV volume in heart-failure patients following PLV resulted at short-term in unchanged SV, increases in LVEF, and decreases in peak wall stress. The increase in LV synchrony with PLV suggests that the transition to a more uniform LV contraction and relaxation pattern might be a rationale of the working mechanism of PLV.

• Authors: J J Schreuder, P Steendijk, F H van der Veen, O Alfieri, T van der Nagel, R Lorusso, J M van Dantzig, K B Prenger, J Baan, H J Wellens, R J Batista
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 36 Issue 7 Pg. 2104-14 (Dec 2000) ISSN: 0735-1097 [Print] United States
• PMID: 11127448 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Cardiomyopathy, Dilated (physiopathology, surgery)
• Female
• Heart Ventricles (surgery)
• Hemodynamics
• Humans
• Male
• Middle Aged
• Myocardial Contraction
• Stroke Volume
• Treatment Outcome
• Ventricular Function, Left