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Functional Changes After Partial Left Ventriculectomy and Mitral Valve Repair Assessed by Gated Perfusion SPECT

¹ Department of Nuclear Medicine, University Hospital, Münster, Germany
² Institute of Arteriosclerosis Research, Westfälische Wilhelms-University, Münster, Germany
³ Department of Cardiology and Angiology, University Hospital, Münster, Germany
⁴ Department of Cardiothoracic Surgery, University Hospital, Münster, Germany
⁵ Department of Anesthesiology and Operative Intensive Care, University Hospital, Münster, Germany

A myocardial remodeling in dilated cardiomyopathy (DCM) after partial left ventriculectomy (PLV) has been previously discussed. The aim of this study was to investigate the functional changes in the follow-up of patients with DCM undergoing PLV using electrocardiographically triggered perfusion SPECT (gated SPECT). Methods: Twelve DCM patients (10 men, 2 women; 56 ± 9 y [mean ± SD]), after successful PLV and mitral valve repair (PLV–MVR), were monitored by gated SPECT and echocardiography. Gated SPECT quantified end-diastolic volumes (EDV), end-systolic volumes (ESV), myocardial and scar volumes, as well as ejection fraction (EF) preoperatively, early (38 ± 28 d), and late (296 ± 130 d) after PLV–MVR. Results: EDV and ESV showed an immediate reduction after PLV–MVR (EDV from 542 ± 90 mL to 350 ± 81 mL, P < 0.001; ESV from 452 ± 91 mL to 254 ± 79 mL, P < 0.001) with no significant change in the late follow-up (EDV late, 316 ± 63 mL; ESV late, 207 ± 63 mL; both P = not significant vs. early follow-up). PLV–MVR immediately improved EF (preoperative, 16.8% ± 5.5%; early, 28.8% ± 7.6%; P = 0.003) with no significant change in the late follow-up (36.0% ± 9.4%; P = not significant vs. early follow-up). Conclusion: In this highly selected DCM patient group, gated perfusion SPECT assessed early responses in volumes and EF after PLV–MVR. However, although statistically nonsignificant in the small patient group, ESV and EDV were further decreased, whereas EF improved toward 1 y, coinciding with the improvement of clinical symptoms (New York Heart Association), potentially indicating a functional remodeling after PLV–MVR. Further studies in larger patient cohorts and longer follow-up are warranted.

Key Words: gated SPECT • partial left ventriculectomy • dilated cardiomyopathy • echocardiography

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