End-systolic volume following surgical ventricular reconstruction impacts survival in patients with ischaemic dilated cardiomyopathy

Aims A left ventricular end-systolic volume (LVESV) ≥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 2 following SVR.Methods and resultsAll 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 ≥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 ≥ 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 ≥60 mL/m ². Risk of all-cause death was significantly higher in Group 1. Post-operative LVESVI of ≥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].ConclusionOur 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).