Effects of Surgical Ventricular Reconstruction and Mitral Complex Reconstruction on Cardiac Oxidative Metabolism and Efficiency in Nonischemic and Ischemic Dilated Cardiomyopathy

• Published in: JACC. Cardiovascular imaging Vol. 4; no. 7; pp. 762 - 770
• Main Authors: Sugiki, Takashi, MD, PhD, Naya, Masanao, MD, PhD, Manabe, Osamu, MD, Wakasa, Satoru, MD, PhD, Kubota, Suguru, MD, PhD, Chiba, Satoru, MD, PhD, Iwano, Hiroyuki, MD, Yamada, Satoshi, MD, PhD, Yoshinaga, Keiichiro, MD, PhD, Tamaki, Nagara, MD, PhD, Tsutsui, Hiroyuki, MD, PhD, Matsui, Yoshiro, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States 01.07.2011
• Subjects: Acetates - metabolism; Adult; Aged; Cardiac Surgical Procedures; Cardiomyopathy, Dilated - diagnosis; Cardiomyopathy, Dilated - etiology; Cardiomyopathy, Dilated - metabolism; Cardiomyopathy, Dilated - physiopathology; Cardiomyopathy, Dilated - surgery; Cardiovascular; Echocardiography, Doppler, Color; Echocardiography, Doppler, Pulsed; Energy Metabolism; Female; Heart Failure - diagnosis; Heart Failure - etiology; Heart Failure - metabolism; Heart Failure - physiopathology; Heart Failure - surgery; Heart Ventricles - metabolism; Heart Ventricles - physiopathology; Heart Ventricles - surgery; Humans; Japan; Male; Middle Aged; Mitral Valve Insufficiency - diagnosis; Mitral Valve Insufficiency - etiology; Mitral Valve Insufficiency - metabolism; Mitral Valve Insufficiency - physiopathology; Mitral Valve Insufficiency - surgery; Myocardial Ischemia - complications; Myocardium - metabolism; Oxidation-Reduction; Positron-Emission Tomography; Recovery of Function; Severity of Illness Index; Time Factors; Treatment Outcome; Ventricular Function, Left; Japan; SV LVOT; LVM; LVEF; LVESV; LV; monoexponential clearance rate of 11C-acetate from the myocardium; cardiac efficiency; left ventricular mass; left ventricular ejection fraction; SVR; New York Heart Association; surgical ventricular reconstruction; left ventricular end-diastolic volume; stroke volume at left ventricular outflow tract; LVEDV; left ventricular; left ventricular end-systolic volume; NYHA; cardiac heart failure; K mono; nonischemic dilated cardiomyopathy; mitral complex reconstruction; DCM; work metabolic index; ICM; OLVP; WMI; ischemic dilated cardiomyopathy; cardiac positron emission tomography; positron emission tomography; MCR; overlapping left ventriculoplasty; PET
• ISSN: 1936-878X; 1876-7591
• DOI: 10.1016/j.jcmg.2011.04.010

Objectives The aim of this study was to investigate the effects of surgical ventricular reconstruction (SVR) on cardiac efficiency as a surrogate marker for cardiac function and oxidative metabolism in patients with severe heart failure. Background Our new integrated overlapping left ventriculoplasty, modified SVR, combined with mitral complex reconstruction, reduce left ventricular (LV) volume associated with improvement of symptoms of heart failure. Methods Twelve consecutive patients with end-stage heart failure due to nonischemic dilated cardiomyopathy (DCM) (n = 6) and ischemic dilated cardiomyopathy (ICM) (n = 6) who underwent SVR were studied. Myocardial oxidative metabolism per gram of tissue was estimated by monoexponential clearance of11 C-acetate positron emission tomography (Kmono ). Forward stroke volume at the LV outflow tract was measured by echocardiography. Cardiac efficiency was estimated by the ratio of external work (stroke volume at the LV outflow tract index × systolic blood pressure × heart rate) to Kmono before and 1 month after SVR. Results After SVR, medians of New York Heart Association functional class significantly improved from 3 to 1.5 (p < 0.01) in both DCM and ICM patients. End-systolic and end-diastolic volume and LV mass significantly decreased in both groups. Stroke volume at the LV outflow tract increased from 43 ± 8 ml to 52 ± 11 ml (p = 0.028) in DCM patients, but not in ICM patients (49 ± 21 ml to 59 ± 26 ml, p = 0.12). Kmono × LV mass, as an index of global LV oxidative metabolism, decreased in DCM patients (13.6 ± 1.9 g/min vs. 8.6 ± 1.5 g/min, p = 0.03) and ICM patients (12.0 ± 3.4 g/min vs. 9.2 ± 1.0 g/min, p = 0.06). As a result, cardiac efficiency increased in all patients with DCM (3.34 ± 0.46 × 10E6 vs. 4.74 ± 0.88 × 10E6 mm Hg·ml·min/m2 , p = 0.03) and in 5 of 6 patients with ICM (4.54 ± 1.66 × 10E6 vs. 5.99 ± 2.11 × 10E6 mm Hg·ml·min/m2 , p = 0.12). Conclusions Combined surgery with SVR and mitral complex reconstruction reduced LV volume in association with improvement of cardiac efficiency in patients with severe heart failure.