Regional wall motion analysis predicts survival and functional outcome after subendocardial resection in patients with prior anterior myocardial infarction.

Abstract

Subendocardial resection is an established surgical technique for the treatment of ventricular tachycardia associated with prior myocardial infarction. Preoperative factors predictive of survival and functional outcome after surgery have not been completely characterized. We hypothesized that a quantitative assessment of regional wall motion would be a sensitive predictor of both survival and functional outcome after subendocardial resection. This was retrospectively tested in a group of 80 patients with prior anterior myocardial infarction who had undergone subendocardial resection for sustained ventricular tachycardia at out institution. Centerline chord motion analysis was used to derive a wall motion score from the preoperative contrast right anterior oblique ventriculogram. Multivariate analysis revealed wall motion score to be a significant independent predictor of both long-term survival (p < 0.01) and New York Heart Association (NYHA) functional class I or II status at 6 months (p < 0.01) and at 24 months (p < 0.001) after surgery. Patients with a wall motion score of > 16%, compared with patients with a wall motion score of < or = 16%, had a better 5-year actuarial survival (74% versus 45%, p = 0.02) and were more likely to be NYHA class I or II at 6 months (87% versus 58%, p < 0.01) and at 24 months (82% versus 34%, p < 0.0001) after subendocardial resection. A wall motion score derived from centerline chord motion analysis is a sensitive predictor of survival and functional outcome after subendocardial resection. Patients with a wall motion score of > 16% have an excellent prognosis after subendocardial resection. In contrast, patients with a wall motion score of < or = 16% have a poorer outcome and should be considered candidates only if other forms of therapy have failed or are unavailable.