Long-term outcomes of surgical ventricular reconstruction: Insight from cardiac magnetic resonance.

Overview

abstract

OBJECTIVES: Surgical ventricular reconstruction (SVR) is used to treat selected patients with ischemic heart failure (HF). We evaluated clinical and cardiac magnetic resonance (CMR) outcomes after SVR and identified predictors of long-term survival in one of the largest reported SVR series. METHODS: 126 patients with severe left ventricular (LV) systolic dysfunction and symptomatic HF underwent SVR at a single center. All patients underwent CMR with late gadolinium enhancement (LGE) before and six months after surgery. Cox regression was used to identify predictors of all-cause mortality. RESULTS: All patients had a previous myocardial infarction and symptomatic HF. At baseline, 61 patients (48 %) were in NYHA III, with a median NT-proBNP of 1464.5 pg/mL [707.0-2650]. Median LV end-diastolic (LVEDVi) and end-systolic volume index (LVESVi) were 129.7 and 91.2 mL/m², respectively; mean LV ejection fraction (LVEF) was 27.9 % ± 9.2. Moderate-to-severe mitral regurgitation (MR) was present in 50 % of the patients. At 6-month, NYHA class III prevalence dropped from 49 % to 8 % (p = 0.001), and LVEF improved to 39.3 % (p < 0.001). Among CMR parameters, only LGE/LVEDVi was associated with mortality. Over a median follow-up of 6.4 years, age (HR 1.089 [1.013-1.170]), NYHA class III (HR 3.231 [1.043-10.009]), moderate-to-severe MR (HR 4.252 [1.259-14.363]), pulmonary artery systolic pressure (PASP; HR 1.034 [1.001-1.069]), and LGE/LVEDVi ratio (HR 0.017 [0.000-0.783]) were independent predictors of all-cause death. CONCLUSIONS: In patients with ischemic HF, symptoms and LV function improved after SVR. Long-term survival was predicted by clinical and imaging variables, including the new LGE/LVEDVi.