Left ventricular function and survival in ischemic cardiomyopathy: Implications for surgical ventricular restoration

Abstract

Objectives: This pilot study evaluates the association of relative wall thickness (RWT) on survival in patients with ischemic cardiomyopathy (ICM). We hypothesized that patients with preserved RWT may be better candidates for surgical ventricular restoration than those with thinner RWT.Methods: Echocardiography was performed in 165 consecutive patients (aged 58.2 AE 14.7 years) divided into 2 groups based on RWT values. Group 1 had patients with preserved RWT and group 2 had patients with reduced RWT.Results: There were 120 (72.7%) patients with hypertension and 112 (67.8%) patients had diabetes mellitus. The patients with preserved RWT (group 1) had significantly more hypertension and diabetes. The patients with decreased RWT (group 2) were in a higher New York Heart Association functional class and had significantly greater incidence of anterior wall myocardial infarction. The entire cohort was followed over 24 months (group 1: n ¼ 117 and group 2: n ¼ 48). The overall all-cause mortality in group 1 (preserved RWT) was 7 (5.9%) and in group 2 (reduced RWT) was 35 (72.9%) (P < .0001). When readmission for congestive heart failure was analyzed, group 2 patients with lower RWT (P < .0001) had an increased rate of readmissions for heart failure. Conclusions:In patients with ischemic cardiomyopathy, a lower RWT indicative of dilated LV remodeling was associated with increased mortality and readmission for heart failure. The RWT may be a simple benchmark of viable or contractile myocardium in ICM. It can be hypothesized that patients with preserved RWT may benefit from surgical ventricular restoration. (JTCVS Open 2021;7:211-8)A rectangular intraventricular patch, excluding the left ventricular aneurysm during SVR.

Effect of Left Ventricular Restrictive filling pattern on survival in ischemic cardiomyopathy: Implications for surgical ventricular restoration.

“…The left atrial dimensions were also significantly greater, as was the deceleration time, which are indirect indicators of diastolic dysfunction. When followed over 24 months, there was a significantly higher all-cause mortality and significantly greater readmissions for heart failure in patients with decreased RWT [19].…”

Commentary: Measure twice, cut once: Does a “STICH” in time truly save nine?

“…In the current manuscript, Adhyapak and colleagues 1 report the findings of their pilot study, which aimed to define the patient populations with ischemic cardiomyopathy that may benefit from surgical ventricular restoration (SVR). The basic premise and hypothesis of their study is that patients with preserved relative wall thickness (RWT) might be better candidates for left ventricular surgical remodeling (LVSR).…”

Commentary: Surgical ventricular reconstruction is the right choice

“…The risk of an unsuccessful procedure is related to the extension of the myocardial scar, to the contractility of the remote myocardium, not involved in infarcted area, and to the thickness of the posterior wall, which, in the case of anterior infarction, is a good indicator of function. 4 In this issue of JTCVS Open , Adhyapak and colleagues 5 report their experience with SVR in a population of 165 patients. They investigated the relative wall thickness (RWT) as a predictor of outcome.…”