Evaluation of predictors of clinical outcome after partial left ventriculectomy

Abstract

Background. Outcome after partial left ventriculectomy (PLV) is difficult to predict. Our goal was to determine if clinical measurements including exercise testing could predict outcome after PLV. Methods. Sixteen patients with dilated cardiomyopathy had left ventricular ejection fraction, left ventricular end-diastolic diameter, amount of mitral regurgitation (MR), New York Heart Association (NYHA) functional class, and cardiopulmonary exercise testing measurements measured before PLV and 3 months after PLV. Eleven patients who remained stable after PLV (group 1) were compared with 5 patients who deteriorated after PLV (group 2). Results. Similar significant improvements were seen in both groups 3 months post-PLV with respect to left ventricular ejection fraction (group 1: 0.136 ± 0.037 to 0.212 ± 0.046; group 2: 0.139 ± 0.042 to 0.179 ± 0.073) and left ventricular end-diastolic diameter (group 1: 8.5 ± 0.7 to 7.0 ± 0.6 cm; group 2: 7.6 ± 0.6 to 6.5 ± 0.6 cm). The MR grade (1.0 ± 0.6 versus 2.5 ± 0.6), NYHA functional class (1.5 ± 0.31 versus 2.5 ± 0.6), and peak oxygen consumption (17.8 ± 1.1 versus 12.2 ± 2.0) were significantly different in the two groups 3 months after PLV ( p < 0.05, analysis of variance). Conclusions. Patients that do not show significant improvement in peak oxygen consumption, NYHA class and significant decrease in the amount of MR 3 months after PLV, compared with pre-PLV, are at increased risk of clinically deteriorating.