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J Thorac Cardiovasc Surg 2005;130:615
© 2005 The American Association for Thoracic Surgery

Letters to the Editor

Acute decrease of left ventricular mechanical dyssynchrony and improvement of contractile state and energy efficiency after left ventricular restoration

Lognathen Balacumaraswami, FRCS, Serban Stoica, MD, Paul White, PhD, Stephen R. Large, FRCS

Papworth Hospital, Cambridge, United Kingdom

To the Editor:

We congratulate Dr Schreuder and colleagues 1 Go on their study of intraoperative left ventricular (LV) performance after endoventricular patch aneurysmectomy. In this series of 9 consecutive patients, the study demonstrates significant reduction in end-diastolic volume and increase in ejection fraction and LV energy efficiency.

However, we would counsel caution in this interpretation due to what we believe are three inherent flaws in the study methods.

First, the hemodynamic data highlight a significant difference in the heart rate before and after aneurysmectomy. It is widely established that an increase in heart rate proportionately alters LV systolic function and ejection fraction by virtue of the force-frequency relationship. 2 Go

Second, 7 of 9 patients underwent coronary artery bypass grafting, which may contribute to the increase in LV performance by reversal of hibernation. The authors discuss the potential independent effects of bypass grafting, but not the critical issue of the contribution of hibernating myocardium to LV function. We suspect that this factor may be responsible for augmented LV systolic function and ejection fraction. 3 Go

Third, there is no information regarding the severity of mitral regurgitation. This can cause spurious recording of increased LV performance due to inappropriate offloading of the left ventricle. 4 Go

Notwithstanding these issues, we believe that this is a valuable study contributing required evidence to support objective improvement in LV function with reverse remodelling surgery.

References

  1. Schreuder JJ, Castiglioni A, Maisano F, Steendijk P, Donelli A, Baan J, et al. Acute decrease of left ventricular mechanical dyssynchrony and improvement of contractile state and energy efficiency after left ventricular restoration. J Thorac Cardiovasc Surg. 2005;129:138-145.[Abstract/Free Full Text]
  2. Bohm M, LaRosee K, Schmidt U, Schulz C, Schwinger RH, Erdmann E. Force-frequency relationship and inotropic stimulation in the nonfailing and failing human myocardium. implications for the medical treatment of heart failure. Clin Investig. 1992;70:421-425.[Medline]
  3. Louie HW, Laks H, Milgalter E, Drinkwater Jr DC, Hamilton MA, Brunken RC, et al. Ischemic cardiomyopathy. criteria for coronary revascularization and cardiac transplantation. Circulation. 1991;84(suppl III):III290.[Abstract/Free Full Text]
  4. McCarthy PM. Ventricular aneurysms, shock, and late follow-up in patients with heart failure. J Thorac Cardiovasc Surg. 2003;126:323-325.[Free Full Text]




This Article
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Lognathen Balacumaraswami
Serban Stoica
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Right arrow Articles by Balacumaraswami, L.
Right arrow Articles by Large, S. R.
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Right arrow Transplantation - heart

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