Department of Critical Care Medicine, University of Florence, Florence, Italy.
Eur J Heart Fail. 2010 Apr;12(4):375-81. doi: 10.1093/eurjhf/hfq020. Epub 2010 Feb 25.
A left ventricular end-systolic volume (LVESV) > or =60 mL/m(2) has been shown to be associated with increased cardiac mortality after a reperfused myocardial infarction (MI). The reduction in LVESV following surgical ventricular reconstruction (SVR) is reported to be between 19% and 50% but its impact on prognosis is not well-established. The aim of this study was therefore to assess the impact on survival of a residual LVESV index (LVESVI) of > or = or <60 mL/m(2) following SVR.
All patients undergoing SVR at our Centre between July 2001 and March 2009 were eligible to be included in this study if they had a preoperative LVESVI of > or =60 mL/m(2) and an LVESVI measurement performed at discharge (7-10 days after surgery). Two hundred and sixteen patients (aged 64 +/- 9 years, 33 women) satisfied these criteria. Coronary artery bypass graft was performed in 197 patients (91.2%) and mitral repair in 63 patients (29%). Left ventricular ESVI had decreased by 41% at discharge in the overall population. Patients were grouped according to the residual LVESVI at discharge as follows: Group 1, LVESVI > or = 60 mL/m(2) (n = 71), and Group 2, LVESVI < 60 mL/m(2) (n = 145). In both groups, LVESVI decreased significantly with respect to baseline, by 29% in Group 1 and by 47% in Group 2. At multivariate analysis, the presence of a non-Q-wave MI and a preoperative internal diastolic diameter of 65 mm were the strongest predictors of a residual post-operative LVESVI of > or =60 mL/m(2). Risk of all-cause death was significantly higher in Group 1. Post-operative LVESVI of > or =60 mL/m(2) was an independent predictor of mortality at follow-up [Exp(B) = 10.7, CI: 2.67-42.9, P = 0.001].
Our findings confirm the role of LVESVI in predicting survival following SVR; the lack of additional improvement in survival with SVR observed in the STICH trial might be due to the inadequate volume reduction (-19%).
左心室收缩末期容积（LVESV）>或=60ml/m2 已被证明与再灌注心肌梗死后的心脏死亡率增加有关。据报道，心脏室壁瘤切除术（SVR）后 LVESV 减少 19%至 50%，但其对预后的影响尚未得到很好的证实。因此，本研究的目的是评估 SVR 后残余 LVESV 指数（LVESVI）>或=60ml/m2 对生存的影响。
如果在 2001 年 7 月至 2009 年 3 月期间在我们中心接受 SVR 的所有患者术前 LVESVI>或=60ml/m2 且在出院时（手术后 7-10 天）进行 LVESVI 测量，则有资格纳入本研究。符合这些标准的 216 名患者（年龄 64 +/- 9 岁，33 名女性）。197 名患者（91.2%）接受冠状动脉旁路移植术，63 名患者（29%）接受二尖瓣修复术。总体人群出院时左心室 ESVI 减少 41%。根据出院时的残余 LVESVI 将患者分为以下两组：组 1，LVESVI>或=60ml/m2（n=71），组 2，LVESVI<60ml/m2（n=145）。在两组中，LVESVI 与基线相比均显著下降，组 1 下降 29%，组 2 下降 47%。多变量分析显示，非 Q 波 MI 的存在和术前内部舒张直径 65mm 是术后残余 LVESVI>或=60ml/m2 的最强预测因子。组 1 的全因死亡率明显较高。术后 LVESVI>或=60ml/m2 是随访时死亡的独立预测因子[Exp（B）=10.7，CI：2.67-42.9，P=0.001]。
我们的研究结果证实了 LVESVI 在预测 SVR 后生存中的作用；STICH 试验中观察到 SVR 后生存无明显改善可能是由于容量减少不足（-19%）所致。
