Abstract 2324: Impact of Left Ventricular Regional Fibrosis Quantified by Delayed Enhancement Magnetic Resonance Imaging on Outcomes of Ventricular Restoration and Restrictive Mitral Annuloplasty
Background; Delayed enhancement magnetic resonance imaging (DE-MRI) can determine the extent of myocardial scarring. However, it is unclear if presence of scar has prognostic values in patients undergoing surgical heart failure therapy. We examined how the myocardial scarring influences the outcomes of surgical ventricular restoration (SVR) and restrictive mitral annuloplasty (RMA) for ischemic heart failure patients.
Methods and Results; In 29 consecutive patients (mean left ventricular ejection fraction 23 ± 8.3%, NYHA class 3.1 ± 0.6), assessment of left ventricular (LV) myocardium by DE-MRI was performed before the operation. All patients underwent SVR and/or RMA in addition to complete revascularization. Regional myocardial scarring was quantified at the basal, mid, and apical LV on the basis of the amount of hyperenhancement area and calculated as percentage of fibrosis. We assessed the relationships between regional percentage of fibrosis and postoperative hemodynamic and clinical variables. Degree of percentage of LV basal fibrosis was the strongest predictor of postoperative hemodynamic variables and less recovery of LV function; LV ejection fraction (p = .0005, R = −.60), LV end-systolic volume index (p = .002, R = 0.55), mean pulmonary artery pressure (p = .0002, R = .65). The greater improvement of LV ejection fraction was obtained in patients with lower LV basal fibrosis (p = .0001, R = .66). During a mean follow-up of 2.2 years, 6 patients developed recurrent heart failure. Those had significantly larger percentage of LV basal fibrosis than those without recurrence of heart failure (19% versus 8.4%, p = .012). Multivariable analysis demonstrated that percentage of LV basal fibrosis was the independent predictor of recurrent heart failure (odds ratio, 1.17; p = .04).
Conclusion; In patients undergoing surgical heart failure therapy with SVR and RMA, the extent of LV basal fibrosis characterized by DE-MRI is an useful predictor of adverse outcomes.