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Effects of Surgical Ventricular Restoration on Left Ventricular Function: Dynamic MR Imaging¹

¹ From the Center for Integrated Non-Invasive Cardiovascular Imaging of the Departments of Radiology (Section of Cardiovascular Imaging) (B.B.C., R.M.S., A.E.S., J.A.W., A.G.L., R.D.W.), Cardiovascular Medicine (R.C.S., J.B.Y., R.D.W.), and Thoracic and Cardiovascular Surgery (N.G.S., P.M.M., R.D.W.), and the Department of Biostatistics and Epidemiology (M.L.L.), Cleveland Clinic Foundation, Desk Hb6, 9500 Euclid Ave, Cleveland, OH 44195. Received August 26, 2005; revision requested October 25; revision received December 2; accepted January 5, 2006; final version accepted February 10. B.B.C. supported by the RSNA Research and Education Foundation. Address correspondence to R.D.W. (e-mail: richard.white{at}jax.ufl.edu).

Purpose: To retrospectively evaluate with dynamic magnetic resonance (MR) imaging the changes in global and regional left ventricular (LV) function after surgical ventricular restoration (SVR) performed in chronic ischemic heart disease patients with large nonaneurysmal or aneurysmal postmyocardial infarction zones.

Materials and Methods: The study was performed with institutional review board approval, and a waiver of individual informed consent was obtained. The study was HIPAA compliant. Patients (83 men, 22 women; mean age, 61 years ± 9 [standard deviation]) were evaluated with MR imaging before and after SVR as follows: pre-SVR examination (n = 105; 25 days ± 39 before SVR; median, 7 days; range, 1–189 days), early post-SVR examination (n = 95, 7 days ± 3 after SVR), and late post-SVR (n = 35, 313 days ± 158 after SVR). Cine MR imaging allowed calculation of ejection fraction and rate-corrected velocity of circumferential fiber shortening (Vcf_C) for global LV functional evaluation, whereas tagged MR imaging (spatial modulation of magnetization with harmonic phase analysis) permitted assessment of regional circumferential strain (E_C) with coronary distribution. Vcf_C and E_C were computed at both LV base- and mid-LV short-axis levels remote from the site of anteroapical SVR.

Results: Prior to SVR, LV dilatation and diminished global and regional LV function were observed. At early post-SVR examination, Vcf_C had improved significantly but E_C showed a worsening trend overall, although only E_C of the right coronary artery at the mid-LV level worsened significantly. At late post-SVR examination, Vcf_C values were improved when compared with pre-SVR values, although E_C showed no statistically significant improvement. When compared with that at early post-SVR examination, however, E_C showed significant improvement in two segments: left anterior descending artery and right coronary artery at mid-LV level.

Conclusion: Although volume-based indexes of global LV function improve significantly after SVR, regional LV function did not improve significantly; there was evidence of continued LV remodeling after SVR.

© RSNA, 2006

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