Arquivos Brasileiros de Cardiologia (Dec 2009)
Importância da área de fibrose na evolução em médio prazo de pacientes submetidos à reconstrução ventricular Importancia del área de fibrosis en la evolución a mediano plazo de pacientes sometidos a reconstrucción ventricular Importance of the area of fibrosis at midterm evolution of patients submitted to ventricular reconstruction
Abstract
FUNDAMENTO: Embora se reconheça que a cirurgia de reconstrução ventricular (CRV) promova remodelamento reverso, são necessários novos estudos para definir a influência da área de fibrose do ventrículo esquerdo (VE). OBJETIVO: Avaliar se a extensão da área de fibrose do VE é importante na recuperação funcional ventricular após CRV e correlacionar com fatores clínicos. MÉTODO: Análise prospectiva de 82 pacientes com disfunção ventricular submetidos à CRV. Analisou-se a importância das características clínicas e foram avaliadas as quantidades de fibrose, mensuradas por ressonância magnética em pequena, média e grande. RESULTADOS: Todos os pacientes foram acompanhados por 36 meses, com mortalidade de 6%. A quantidade de fibrose média foi de 25,8% ± 13,6%. Houve melhora da fração de ejeção do VE (FEVE), de 36,9% ± 6,8% para 48,2% ± 8,2% (p FUNDAMENTO: Si bien se reconoce que la cirugía de reconstrucción ventricular (CRV) promueve remodelación reversa, son necesarios nuevos estudios para definir la influencia del área de fibrosis del ventrículo izquierdo (VE). OBJETIVO: Evaluar si la extensión del área de fibrosis del VI es importante en la recuperación funcional ventricular tras la CRV y correlacionarlo con factores clínicos. MÉTODO: Análisis prospectivo de 82 pacientes con disfunción ventricular sometidos a CRV. Se analizó la importancia de las características clínicas y se evaluaron las áreas de fibrosis, medidas por resonancia magnética y ponderadas como pequeña, mediana y grande. RESULTADOS: Se realizó un seguimiento de 36 meses a todos los pacientes, con mortalidad del 6%. La cantidad de fibrosis promedio fue del 25,8% ± 13,6%. Existió una mejora de la fracción de eyección del VI (FEVI), del 36,9% ± 6,8% al 48,2% ± 8,2% (p BACKGROUND: Although it is acknowledged that the ventricular reconstruction surgery (VRS) can promote reverse remodeling, new studies are necessary to define the influence of the left ventricular (LV) area of fibrosis. OBJECTIVE: To evaluate whether the extension of the area of fibrosis of the LV is important in the LV functional recovery after the surgery and correlate it with clinical factors. METHODS: Prospective analysis of 82 patients with ventricular dysfunction submitted to VRS. We analyzed the importance of the clinical characteristics and the amount of fibrosis was assessed, measured by cardiac magnetic resonance (CMR) as small, medium and large. RESULTS: All patients were followed for 36 months, with a mortality of 6%. The amount of medium fibrosis was 25.8% ± 13.6%. There was improvement in the left ventricular ejection fraction (LVEF), from 36.9% ± 6.8% to 48.2% ± 8.2% (p < 0.001). There was an inverse association between the amount of fibrosis and the increase in LVEF (r = -0.83, p < 0.0001). There was a decrease in the LV end-systolic volume of 43.3 ± 8.2ml/m² (p < 0.001). There was an improvement in heart failure symptoms, except in patients with large areas of fibrosis (p = 0.45). The independent predictors for events were: fibrotic area (p = 0.01), age (p = 0.01), LV end-systolic volume (p = 0.03) and LVEF (p = 0.02). The event-free follow-up was different in relation to the area of fibrosis (p < 0.01). CONCLUSION: In patients with ventricular dysfunction, the extension of the area of fibrosis was an independent predictor of the LV functional recovery after the VRS. The combination of cardiac MRI and clinical parameters can help in the indication for VRS.
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