Department of Cardiac Surgery, IRCCS San Donato Hospital, Milan, Italy.
J Thorac Cardiovasc Surg. 2010 Aug;140(2):285-291.e1. doi: 10.1016/j.jtcvs.2009.10.027. Epub 2009 Dec 28.
Limited data are available on the effects of surgical ventricular reconstruction on diastolic function. The aim of the present study was to evaluate changes in diastolic function induced by surgical ventricular reconstruction at 2 time intervals after surgery (discharge and follow-up) and to assess the impact of diastolic changes on clinical outcome.
A total of 129 patients (65 +/- 9 years, 14 women) underwent echocardiographic Doppler evaluation before surgical ventricular reconstruction, at discharge, and at follow-up (median 7 months). Patients with mitral regurgitation were excluded. Diastolic pattern was graded as follows: 0 (normal), 1 (abnormal relaxation), 2 (pseudo normalization), 3 (restrictive, reversible), and 4 (restrictive, irreversible).
At follow-up, 28 (21.7%) of 129 patients showed a restrictive diastolic pattern (grade 3-4; group 1) and 101 did not (diastolic pattern grade 0-2; group 2). Preoperative and postoperative factors strongly associated with late diastolic restriction included sphericity index (higher in group 1), ventricular shape (nonaneurysmal shape more frequent in group 1), internal dimensions (greater in group 1), diastolic pattern (higher in group 1), ejection fraction (lower in group 1); left atrial dimensions (greater in group 1); mitral regurgitation rate (higher in group 1). At multivariate analysis the most powerful predictors of restriction were preoperative pseudonormalization of diastolic pattern (diastolic pattern 2) and septolateral dimensions (short axis). Overall, ejection fraction improved from 33% +/- 9% to 40% +/- 9% to 40% +/- 9%; P = .001; end-diastolic and end-systolic volumes decreased (112 +/- 41 to 73 +/- 21 to 88 +/- 28 mL/m(2), respectively; P = .001; and 77 +/- 38 to 44 +/- 17 to 52 +/- 24 mL/m(2), respectively; P = .001); New York Heart Association class improved (2.4 +/- 0.8 to 1.6 +/- 0.6; P = .001).
Mild preoperative diastolic dysfunction (pseudonormalized pattern) and increased septolateral dimensions are independent predictors of diastolic restriction after surgical ventricular reconstruction.
关于外科心室重构对舒张功能影响的数据有限。本研究旨在评估手术后 2 个时间点（出院和随访）外科心室重构引起的舒张功能变化，并评估舒张变化对临床结果的影响。
共 129 例患者（65±9 岁，14 名女性）在外科心室重构前、出院时和随访时（中位数 7 个月）接受超声心动图多普勒评估。排除二尖瓣反流患者。舒张模式分为以下几类：0（正常）、1（松弛异常）、2（假性正常化）、3（限制型，可恢复）和 4（限制型，不可恢复）。
随访时，129 例患者中有 28 例（21.7%）出现限制性舒张模式（分级 3-4；组 1），101 例无限制性舒张模式（舒张模式分级 0-2；组 2）。与晚期舒张受限密切相关的术前和术后因素包括：球形指数（组 1 较高）、心室形态（组 1 中非瘤样形态更常见）、内径（组 1 较大）、舒张模式（组 1 较高）、射血分数（组 1 较低）；左心房大小（组 1 较大）；二尖瓣反流率（组 1 较高）。多变量分析表明，限制的最强预测因子是术前舒张模式假性正常化（舒张模式 2）和室间隔-侧壁直径。总的来说，射血分数从 33%±9%增加到 40%±9%再到 40%±9%；P=0.001；舒张末期和收缩末期容积减小（112±41 至 73±21 至 88±28ml/m2，分别；P=0.001；77±38 至 44±17 至 52±24ml/m2，分别；P=0.001）；纽约心脏协会（NYHA）心功能分级改善（2.4±0.8 至 1.6±0.6；P=0.001）。
轻度术前舒张功能障碍（假性正常化模式）和室间隔-侧壁直径增加是外科心室重构后舒张受限的独立预测因子。
