Effects of Dynamic Cardiomyoplasty on Regional Wall Motion, Ejection Fraction, and Geometry of Left Ventricle
- Bocchi, Edimar Alcides MD
- Moreira, Luiz Felipe Pinho MD
- de Moraes, Alvaro Vilela MD
- Bellotti, Giovanni MD
- Gama, Marcos MD
- Stolf, Noedir A.G. MD
- Jatene, Adib D. MD
- Pileggi, Fulvio MD
Background
Dynamic cardiomyoplasty may provide functional and hemodynamic improvement in patients with heart failure. The purpose of this study was to investigate the effects of cardiomyoplasty on global ejection fraction, regional wall motion, and geometry of the left ventricle.
Methods and Results
These parameters were determined in 10 patients submitted to cardiomyoplasty for treatment of refractory heart failure by left ventricular (LV) angiography. The studies were performed before and 16.5 ±4.8 months after cardiomyoplasty with the myostimulator turned on. They were repeated 24±1 hours with the myostimulator turned off in eight patients. LV ejection fractions were determined by the area-length method, and the centerline method was used for assessment of regional wall motion. LV geometry was studied by LV major-to-minor axis ratio and sphericity index. A LV ejection fraction improvement from 15±8% to 30.9±8.3% (p<0.01) was demonstrated with the myostimulator turned on after cardiomyoplasty. The values with the myostimulator turned offwere 23±13%, remaining higher than the values observed before surgery (p<0.05). Regional wall motion analysis showed an improvement in all studied regions. Regarding the LV shape, the left ventricle became markedly more spheric in the diastole.
Conclusions
Dynamic cardiomyoplasty may improve LV function in selected patients. The analysis ofLV wall motion corroborated these results, and these changes were associated with modifications in the LV geometry.