Abstract
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Objectives Traditional surgical ventricular reconstruction (SVR) can improve the symptoms in patients with severe heart failure. However, as predicted by theoretical studies, SVR may be associated with diastolic dysfunction limiting the overall beneficial effects. On the other hand, overlapping ventriculoplasty (OLVP) may overcome those limitations. The purpose of this study was to evaluate the effects of OLVP on diastolic function and myocardial oxidative metabolism.
Methods 27 patients undergone OLVP for end stage heart failure due to ischemic (n=15) and non-ischemic cardiomyopathy (n=12). Decelaration time (DT) was measured using echocardiography as diastolic function measurement. Myocardial oxidative metabolism was measured by the monoexponential clearance of C-11 acetate PET (k-mono).
Results OLVP improved NYHA classes and reduced LV end diastolic volume (EDV) in all patients. However, oxidative metabolism assessed by k-mono did not significantly decrease(0.050±0.007/min to 0.047±0.005/min, NS). Echocardiography showed restrictive pattern(DT<160msec) in 18 out of 27 patients before OLVP, and also in 9 after OLVP. DT significantly increased after OLVP (from 127±24 to 179±37msec, P=0.000008) in the group of restrictive pattern(R group). The changes of DT before and after OLVP (delta-DT) negatively correlated with those of k-mono (delta-k-mono) (r=0.58, P<0.05) in R group. On the other hand, the changes of EF, EDV, ESV, PASP, and IVC did not correlate with delta-k-mono.
Conclusions OLVP reduced EDV and improved in NYHA classes in patients with severe heart failure. It also improved diastolic function, which was correlated with a decrease in oxidative metabolism