Real-time three-dimensional echocardiographic study of left ventricular function after infarct exclusion surgery for ischemic cardiomyopathy

Background-Infaret exclusion (IE) surgery, a technique of left ventricular (LV) reconstruction for dyskinetic or akinetic LV segments in patients with ischemic cardiomyopathy, requires accurate volume quantification to determ ine the impact of surgery due to complicated geometric changes. Methods nad Results-Thirty patients who underwent IE (mean age 61+/-8 years , 73% men) had epicardial real-time 3-dimensional echocardiographic (RT3DE) studies performed before and after IE. RT3DE follow-up was performed trans thoracically 42+/-67 days after surgery in 22 patients. Repeated measures A NOVA was used to compare the values before and after IE surgery and at foll ow-up. Significant decreases in LV end-diastolic (EDVI) and end-systolic (E SVI) volume indices were apparent immediately after IE and in follow-up (ED VI 99+/-40, 67+/-26, and 71+/-31 mL/m(2), respectively: ESVI 72+/-37, 40+/- 21, and 42+/-22 mL/m(2), respectively; P<0.05). LV ejection fraction increa sed significantly and remained higher (0.29+/-0.11, 0.43+/-0.13, and 0.42+/ -0.09, respectively, P<0.05). Forward stroke volume in 16 patients with pre operative mitral regurgitation significantly improved after IE and in follo w-up (22+/-12, 53+/-24, and 58+/-21 mL, respectively, P<0.005). New York He art Association functional class at an average 285+/-144 days of clinical f ollow-up significantly improved from 3.0+/-0.8 to 1.8+/-0.8 (P<0.0001). Sma ller end-diastolic and end-systolic volumes measured with RT3DE immediately after IE were closely related to improvement in New York I Heart Associati on functional class at clinical follow-up (Spearman's rho =0.58 and 0.60, r espectively). Conclusions-RT3DE can be used to quantitatively assess changes in LV volume and function after complicated LV reconstruction. Decreased LV volume and increased ejection fraction imply a reduction in LV wall stress after IE su rgery and are predictive of symptomatic improvement.