Effects of Surgical Ventricular Restoration on Left Ventricular Function: Dynamic MR Imaging

Carmichael, Brett; Setser, Randolph M.; Stillman, Arthur E.; Lieber, Michael L.; Smedira, Nicholas G.; McCarthy, Patrick M.; Starling, Randall C.; Young, James B.; Weaver, Joan A.; Lawrence, Angel G.; White, Richard D.

doi:10.1148/radiol.2413051440

Cited by 15 publications

(7 citation statements)

References 31 publications

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“…Kramer and coworkers, 10 in 2002, followed Bogaert and associates' approach 9 and used tagging methods to quantify remote muscle circumferential shortening improvement after restoration, compared the changes to control studies, showed this spatial configuration change (Figure 2, A ), 10 and adhered to the aforementioned surgical study planning concept. Similar findings of remote muscle circumferential deformation improvement were recently reported by Carmichael and associates 11 at the Cleveland Clinic. Editorial suggestions to include this information were not followed, so that a restricted background analysis underlies the article's introductory statements about prior study limitations.…”

supporting

confidence: 89%

Congestive heart failure: Treat the disease, not the symptom

Buckberg

2007

The Journal of Thoracic and Cardiovascular Surgery

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he report by Zhang and associates 1 in this issue applies an important 3-dimensional magnetic resonance imaging (MRI) tagging method to demonstrate that altering ventricular geometry by using the Dor procedure (as they interpreted this operation) in sheep in congestive heart failure increases systolic circumferential shortening in remote muscle. These experimental changes document the clinical improvement in remote muscle function reported worldwide with left ventricular (LV) restoration. 2,3 Such application of advanced imaging methods allows studies to focus on how interventions improve function by changing ventricular muscle deformation that occurs sequentially during the cardiac twisting motion. Furthermore, these regional functional data allow differentiation from nonfunctional remote regions that echocardiographic analysis shows are displaced without contracting, together with providing a time course for displaying how global function is affected by cardiac rebuilding. Normal and Abnormal FormThe surgical approach to congestive heart failure, like other operative objectives, should treat the disease and not the symptom and return structures toward normal shape, as described by others, 4 and this became the title of my 2001 Journal of Thoracic and Cardiovascular Surgery editorial. 5 The geometric disease in ischemic dilated cardiomyopathy is the spherical chamber, which is different than the elliptical or conical normal heart shape (Figure 1). The symptom is the spherical chamber, whereby the normal helical chamber develops a more circular configuration thl at might flatten fiber orientation and alter performance. 6,7 Despite imaging advantages, the experimental design of this study has a major flaw because baseline is ascribed to the infarction state rather than to the normal heart. The authors held fast to repeated requests to supplement their database with a design that introduces normality as a reconstructive guideline for operative interventions. It seems that, aside from supplying superb imaging technology, the surgical planning strategy must also recognize and codify normality (which exists before the infarction), show how disease distorts this (their preoperative control), identify how and why the intervention selected rebuilds normality, and relate results toward the limitations of the selected procedure. For example, if normality was not recaptured, the discussion should identify whether this is a problem with the operative method or related to the timing of postoperative measurements. Border and Remote MusclePrior studies addressed the peri-infarction border zone, showing that the issue was impaired contractile function rather than increased wall stress, 8 and directed

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confidence: 89%

Congestive heart failure: Treat the disease, not the symptom

Buckberg

2007

The Journal of Thoracic and Cardiovascular Surgery

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“…The NYHA classification was I/II in 94% of ESVI < 90 mL/m 2 survivors (47 of 50 patients) and quantifies improved exercise capacity; whereas ongoing dilation among 14 of the 36 surviving patients with an ESVI > 90 mL/m 2 resulted in 39% annual mortality from either CHF or sudden death, confirming the major ICM lethal endpoints. Time‐related improvement in ESVI may result from progressive increments of remote muscle deformation following ventricular rebuilding25 as demonstrated in Figure , which contrasts LV size before, immediately after and late after SVR, in patients who achieved an ESVI < 90 mL/m 2 and >90 mL/m 2 .…”

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confidence: 99%

Volume reduction rate by surgical ventricular restoration determines late outcome in ischaemic cardiomyopathy

Isomura¹,

Hoshino²,

Fukada³

et al. 2011

European J of Heart Fail

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AimsSurgical ventricular restoration (SVR) effectively reduces left ventricular (LV) volume in ischaemic cardiomyopathy (ICM), but the recent Surgical Treatment of Ischemic Heart Failure (STICH) Trial questions its importance. We report 8-year SVR experience in patients with ICM. Methods and resultsBetween 2000 and 2008, 135 patients underwent SVR for ICM. This report analyses data from 90 patients who underwent accurate pre-and post-operative assessment of LV volumes by left ventriculogram or scintigram. All patients also had echocardiograms. Pre-operative LV end-systolic volume index (ESVI) was 123.5 + 53.2 mL/m 2 (range 92-310). Overall, 63 patients were in NHYA class III and 27 were in class IV. The SVR procedure was endoventricular circular patch plasty in 33 patients, septal-anterior ventricular exclusion in 43, and 14 patients had posterior exclusion. Coronary artery bypass grafting was performed in 78 patients (87%) and 50 underwent mitral procedures. Eighteen follow-up late deaths occurred owing to chronic heart failure (n ¼ 12) and sudden death (n ¼ 6). Post-operative ESVI was ,90 mL/m 2 (Group-S) in 54 patients, 90 -120 mL/m 2 (Group-M) in 16, and.120 mL/m 2 (Group-L) in 20 patients. The 8-year survival rate was 82.4% in group-S following a .33% LV volume reduction. In contrast, in Group-M and Group-L, the volume reduction was 15%, and 100% of patients died within 7 years following the SVR procedure (or 0% 8-year survival). ConclusionsSVR is most effective when a .33% volume reduction rate achieves an ESVI of ,90 mL/m 2 . No long-term benefits occur when SVR induces an LV volume reduction of ,15% leaving a residual ESVI .90 mL/m 2 . This database contradicts the STICH trial findings.--

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“…Selvanayagam et al (60) demonstrated that late-enhancement MRI is a powerful predictor of myocardial viability after surgery, suggesting an important role for this technique in clinical viability assessment. Moreover, MRI may be particularly useful for evaluating impaired resting myocardial blood flow in hibernating regions beyond a coronary stenosis, myocardial scarring resulting from revascularization procedures, and improvement in regional myocardial contractility after surgical ventricular reconstruction (60)(61)(62). Pooling of the data from the 4 studies with contrast-enhanced MRI for 132 patients undergoing revascularization revealed a sensitivity of 95% and a specificity of 45% (56).…”

Section: Mrimentioning

confidence: 99%

Assessment of Myocardial Viability in Patients with Heart Failure

Schinkel¹,

Poldermans²,

Elhendy³

et al. 2007

Journal of Nuclear Medicine

134

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The prognosis for patients with chronic ischemic left ventricular dysfunction is poor, despite advances in different therapies. Noninvasive assessment of myocardial viability may guide patient management. Multiple imaging techniques have been developed to assess viable and nonviable myocardium by evaluating perfusion, cell membrane integrity, mitochondria, glucose metabolism, scar tissue, and contractile reserve. PET, 201 Tl and 99m Tc scintigraphy, and dobutamine stress echocardiography have been extensively evaluated for assessment of viability and prediction of clinical outcome after coronary revascularization. In general, nuclear imaging techniques have a high sensitivity for the detection of viability, whereas techniques evaluating contractile reserve have a somewhat lower sensitivity and a higher specificity. MRI has a high diagnostic accuracy for assessment of the transmural extent of myocardial scar tissue. Patients with a substantial amount of dysfunctional but viable myocardium are likely to benefit from coronary revascularization and may show improvements in regional and global contractile function, symptoms, exercise capacity, and long-term prognosis.

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Effects of Surgical Ventricular Restoration on Left Ventricular Function: Dynamic MR Imaging

Abstract: Although volume-based indexes of global LV function improve significantly after SVR, regional LV function did not improve significantly; there was evidence of continued LV remodeling after SVR.

Cited by 15 publications

References 31 publications

Congestive heart failure: Treat the disease, not the symptom

Congestive heart failure: Treat the disease, not the symptom

Volume reduction rate by surgical ventricular restoration determines late outcome in ischaemic cardiomyopathy

Assessment of Myocardial Viability in Patients with Heart Failure

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