Castelvecchio Serenella, Menicanti Lorenzo, Ranucci Marco, Di Donato Marisa
Department of Cardiac Surgery, IRCCS, San Donato Hospital, Milan, Italy.
Ann Thorac Surg. 2008 Dec;86(6):1849-54. doi: 10.1016/j.athoracsur.2008.08.010.
Limited data are available on left ventricle (LV) diastolic function in patients with ischemic dilated cardiomyopathy submitted to surgical ventricular restoration (SVR). The purpose of this study was to assess postoperative diastolic function changes and identify potential predictors of its worsening.
One hundred and forty-six patients (65 +/- 9 years) with previous anterior myocardial infarction were evaluated before and after SVR. Hemodynamic and geometric parameters including the sphericity index and conicity index were measured. Diastolic function was explored using the transmitral flow velocity pattern, and four classes were defined: normal, abnormal relaxation, pseudonormal, and restrictive pattern. Diastolic function was defined as unchanged (no difference in diastolic pattern), improved (at least one class less), or worsened (at least one class more or, in the case of preoperative restrictive pattern, an early transmitral flow velocity to atrial flow velocity [E/A] ratio increase of at least 20%).
The filling pattern before SVR was normal in 7 patients (4.8%), abnormal relaxation in 99 (68%), pseudonormal in 28 (19%), and restrictive in 12 (8.2%). After SVR, the filling pattern was unchanged in 105 patients (72%), improved in 14 (9.6%), and worsened in 27 (18.4%). Based on the univariate analysis, the preoperative conicity index and the end-diastolic volume difference (the result of surgical volume reduction) were associated with a diastolic pattern worsening.
Diastolic function did not change or improve in the majority of patients. In the minority of patients who experienced worsening, this was associated with the preoperative LV shape and residual volume.
关于接受外科心室修复术（SVR）的缺血性扩张型心肌病患者左心室（LV）舒张功能的数据有限。本研究的目的是评估术后舒张功能的变化，并确定其恶化的潜在预测因素。
对146例（65±9岁）既往有前壁心肌梗死的患者在SVR前后进行评估。测量包括球形指数和圆锥指数在内的血流动力学和几何参数。使用经二尖瓣血流速度模式探索舒张功能，并定义了四类：正常、松弛异常、假性正常和限制性模式。舒张功能定义为不变（舒张模式无差异）、改善（至少降低一类）或恶化（至少增加一类，或者在术前为限制性模式的情况下，早期经二尖瓣血流速度与心房血流速度[E/A]比值至少增加20%）。
SVR前的充盈模式正常者7例（4.8%），松弛异常者99例（68%），假性正常者28例（19%），限制性者12例（8.2%）。SVR后，105例患者（72%）的充盈模式不变，14例（9.6%）改善，27例（18.4%）恶化。基于单因素分析，术前圆锥指数和舒张末期容积差（手术减容的结果）与舒张模式恶化相关。
大多数患者的舒张功能未改变或改善。在少数舒张功能恶化的患者中，这与术前左心室形状和残余容积有关。
