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(Circulation. 1995;92:216-222.)
© 1995 American Heart Association, Inc.

Articles

Peak Oxygen Consumption and Resting Left Ventricular Ejection Fraction Changes After Cardiomyoplasty at 6-Month Follow-up

Edimar Alcides Bocchi, MD; Guilherme Veiga Guimarães, PhEd; Luiz Felipe P. Moreira, MD; Fernando Bacal, MD; Alvaro Vilela de Moraes, MD; Antonio Carlos Pereira Barreto, MD; Mauricio Wajngarten, MD; Giovanni Bellotti, MD; Noedir Stolf, MD; Adib Jatene, MD; Fulvio Pileggi, MD

From the Heart Institute, São Paulo (Brazil) University Medical School.

Correspondence to Edimar Alcides Bocchi, MD, Rua Oscar Freire, 2077, Apto 161, Cep 05409-011, São Paulo, Brasil. E-mail: dcl_edimar@pinatubo.incor.usp.br.

Background The effects of cardiomyoplasty on cardiopulmonary exercise test characteristics are not fully known.

Methods and Results We determined in 19 patients who underwent cardiomyoplasty for treatment of refractory heart failure (New York Heart Association [NYHA] functional class III) before (pre) and at 6-month follow-up (post) maximum oxygen consumption (peak O₂), NYHA functional class, and resting left ventricular ejection fraction (LVEF) (MUGA). We analyzed the results according to pre peak O₂ < or >14 mL/kg per minute and the correlation between the changes in absolute values of LVEF and peak O₂. Pre– and post–peak O₂ values were 15.9±4.4 and 18.6±6.4 mL/kg per minute, respectively (P=.059). In the subgroup with pre–peak O₂ <14 mL/kg per minute, the peak O₂ increased from 11.1±1.9 to 16.4±6.2 mL/kg per minute (P=.02). The subgroup with peak O₂ >14 mL/kg per minute showed pre– and post–peak O₂ of 19.2±2.6 and of 20.1±7 mL/kg per minute, respectively (P=.06). The pre–total exercise time of the entire group increased from 688.4±222.1 to 833.7±241.6 seconds (P<.04). For the subgroup with preoperative peak O₂ <14 mL/kg per minute, exercise time improved from 585±76.9 to 825±186.3 seconds (P<.01). In the subgroup with preoperative O₂ >14 mL/kg per minute, the preexercise and postexercise time was 763.6±264.4 and 840±282 seconds, respectively (P=.4). Pre- LVEF increased from 20.6±3.3% to 24.2±7.8% at 6 months of follow-up (P=.02). At 6 months of follow-up, 9 patients were in NYHA functional class I and 10 were in class II. There was no correlation between LVEF values and absolute values of peak O₂ before (r=.123, P=.6) and after (r=.27, P=.2) cardiomyoplasty. A weak correlation was observed between the changes in absolute values of peak O₂ and LVEF from the preoperative to the postoperative period (r=.48, P=.048).

Conclusions Cardiomyoplasty is a useful method for improving NYHA functional class and LVEF in patients with heart failure. Peak O₂ <14 mL/kg per minute before cardiomyoplasty may be a selection criterion with which to determine improved exercise capacity after surgery. The effects of cardiomyoplasty on LVEF appear to be partially associated with maximum exercise capacity changes.

Key Words: cardiomyoplasty • heart failure • exercise