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Acute and short-term effects of partial left ventriculectomy in dilated cardiomyopathy

Assessment by pressure-volume loops

Jan J. Schreuder, MD, PhD , Paul Steendijk, PhD^||, Frederik H. van der Veen, PhD, Ottavio Alfieri, MD, Theo van der Nagel, MS, Roberto Lorusso, MD, PhD, Jan-Melle van Dantzig, MD, PhD, Kees B. Prenger, MD, Jan Baan, PhD^||, Hein J. J. Wellens, MD, PhD and Randas J. V. Batista, MD^*

^* Hospital Angelina Caron, Campina Grande do Sul, Brazil
Department of Cardiac Surgery, San Raffaele Hospital, Milan, Italy
Department of Cardiology, Maastricht, The Netherlands
Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
^|| Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands

View larger version (24K): [in a new window]   Figure 1 P-V loops of Patient 2 during all stages of the PLV procedure. The P-V loops are shifted to the left after the PLV. At the first re-cath after two days, EDP and EDV were increased compared to post-surgery, whereas five days after PLV, both EDP and EDV were lowest.

View larger version (21K): [in a new window]   Figure 2 P-V loops of all eight patients before PLV (thick lines), after PLV (fine lines), and at re-cath two to five days after PLV (dotted lines).

View larger version (21K): [in a new window]   Figure 3 Time-varying wall stress tracings throughout one cardiac cycle of all eight patients before PLV (thick lines), after PLV (fine lines) and at re-cath two to five days after PLV (dotted lines).

View larger version (47K): [in a new window]   Figure 4 Tracings of LV volume segments of Patients 2 and 3 before and after PLV and at re-cath five days after PLV. Vlv = total LV volume in time during four consecutive heart beats. Dotted lines = start of the ejection phase. The pre-PLV segmental synchrony values of Patient 2 were 64%, 62%, 63% and 80% for, respectively, segments 1 through 4 yielding a synchrony index (Sync) of 68%, whereas at re-cath the segmental values were 75%, 77%, 71% and 80% yielding a Sync of 76%.

View larger version (14K): [in a new window]   Figure 5 Linear regression diagram between CI (cardiac index) and Sync (LV synchrony index) of all patients at all stages of the procedure. n = 32, R2 = 0.54, p < 0.0001. All data points fall within 95% prediction limits (dotted lines). The highly significant correlation indicates the synchrony index as an important determinant of CI in this patient group.