Aim: 1. To evaluate the impact of preoperative left ventricular (LV) diastolic function on early and late outcomes in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting (CABG) and surgical ventricular reconstruction (SVR)
2. To investigate the effect of SVR and myocardial revascularization on LV diastolic performance and LV remodeling long term after surgery
3. To assess the predictors for persistence of the restrictive LV diastolic filling pattern (LVDFP) late after SVR and CABG.
Material and method: Prospective study on 157 patients with LV systolic dysfunction (LVEF<30%) who underwent CABG and SVR. Patients were evaluated clinically and by echocardiography (including TDI) preoperatively, early (<1month) and late postoperatively (mean 4,8years). According to the preoperative LVDFP, 3 groups were defined: impaired relaxation, pseudonormal and restrictive LVDFP. Statistical analysis used SYSTAT and SPSS programs for the simple and multiple regression analysis and relative risk calculations.
Results: 1. The presence of a restrictive LVDFP was associated with a greater cardiovascular mortality and hospitalization for heart failure (HF). At 5 years postoperatively, cardiovascular event-free survival was significantly higher in patients with nonrestrictive LVDFP (75%) compared with restrictive LVDFP (55,74%) (p< 0.0001)
2. The multivariate analysis showed the preoperative restrictive LVDFP being an independent and predominant predictor for increasing the early and late postoperative risk of cardiovascular events (p=0.001).
3. The evolution of LVEF, LV end-diastolic volume (LVEDV) and mitral regurgitation (MR) severity was different in patients with nonrestrictive LVDFP (early and late postoperatively these variables improved) compared with restrictive LVDFP (in whom these variables significantly deteriorated late after surgery: LVEF from 27±8% to 22±6%, LVEDV from 181±49 to 234±63 cm3 and MR degree from 0.9±0.6 to 1.8±0.7; p < 0.005)
4. Regression analysis identified as predictors for persistence of a restrictive LVDFP late after surgery: E/E'ratio>12 (RR=19.3), LA dimension index >30mm/m2 (RR=9.2), LVEDV >200cm3 (RR=9.6), severe PHT (RR=11.4), 2 degree MR (RR=14.8).
Conclusions: 1. The preoperative LVDFP has an independent and incremental prognostic value in patients undergoing CABG and SVP, strongly related to higher mortality with aggravation of LV systolic function, MR severity or LV remodeling.
2. The predictors for persistence of a restrictive LVDFP late after CABG and SVR were: E/E' ratio>12, LA dimension index >30mm/m2, LVEDV >200cm3, severe PHT and 2 degree MR.