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J Thorac Cardiovasc Surg 2006;131:357-363
© 2006 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Surgical ventricular reverse remodeling in severe ischemic dilated cardiomyopathy: The relevance of the left ventricular equator as a prognostic factor

Paolo Ferrazzi, MD, FETCS a , * , Marco L.S. Matteucci, MD a , Maurizio Merlo, MD a , Attilio Iacovoni, MD a , Giuseppe Rescigno, MD a , Matteo Bottai, PhD b , Piervirgilio Parrella, ScD a , Luca Lorini, MD a , Michele Senni, MD, FESC a , Antonello Gavazzi, MD, FESC a

a Dipartimento Cardiovascolare Clinico e di Ricerca, Ospedali Riuniti Bergamo, Italy
b Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC

* Address for reprints: Paolo Ferrazzi, MD, Dipartimento Cardiovascolare Clinico e di Ricerca, Ospedali Riuniti, Largo Barozzi 1, 24100 Bergamo, Italy (Email: pferrazzi{at}ospedaliriuniti.bergamo.it).

OBJECTIVES: Surgical ventricular reverse remodeling has been shown to possibly improve hemodynamics and symptoms, but effects on long-term mortality are not established. No consistent data are available on which patients will benefit most from this procedure. This study was designed to analyze the predictors of long-term survival after surgical ventricular reverse remodeling in patients with ischemic cardiomyopathy.

METHODS: Eighty-five patients who underwent surgical ventricular reverse remodeling between May 1991 and October 2003 were retrospectively analyzed. Left ventricular wall motion and left ventricular equatorial diameter were assessed by means of angioventriculography. Left ventricular ejection fraction and volumes were measured by means of echocardiography. Cox regression analysis was used in several combinations to create a final model for identifying predictors of death.

RESULTS: Actuarial survival after 1, 3, 5, and 10 years was 89%, 79%, 75%, and 75%, respectively. New York Heart Association class improved from 2.9 ± 1.0 to 1.3 ± 0.5 (P < .0001), left ventricular ejection fraction increased from 27.6% ± 6.3% to 43.0% ± 10.1% (P < .0001), and left ventricular end-systolic volume index decreased from 89.6 ± 27.6 mL/m2 to 56.5 ± 34.5 mL/m2 (P < .0001). Multivariate analysis identified left ventricular equatorial diameter of 70 mm or greater (hazard ratio, 5.28; 95% confidence interval, 1.79-11.71; P = .020) and segmental akinesia (hazard ratio, 4.46; 95% confidence interval, 1.23-17.12; P = .024) as the only independent predictors of death.

CONCLUSIONS: In this analysis of a single cohort of patients, surgical ventricular reverse remodeling improves the symptoms of ischemic cardiomyopathy, as well as left ventricular function, shape, and volume, with encouraging long-term outcomes, particularly in patients with dyskinesia. A left ventricular equatorial diameter of 70 mm or greater appears to be an important independent prognostic factor, which suggests the relevance of the left ventricular equatorial region for effective surgical reverse remodeling.

Abbreviations and Acronyms ACE = angiotensin-converting enzyme; HF = heart failure; LV = left ventricular; LVEF = left ventricular ejection fraction; LVEqD = left ventricular end-diastolic equatorial diameter; LVESVI = left ventricular end-systolic volume index; MLHF = Minnesota Living With Heart Failure; NYHA = New York Heart Association; SVR = surgical ventricular reverse remodeling




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