Computed Tomography and Speckle-Tracking Echocardiography as Multimodality Imaging Approach for Planning of Surgical Ventricular Restoration

Background: Surgical ventricular restoration (SVR) of left ventricular (LV) aneurysm aims to improve survival and heart failure symptoms through appropriate volume reduction and reshaping of the LV geometry. Our purpose was to refine the planning for SVR using cardiac computed tomography (CCT) and speckle-tracking echocardiography (STE).

Method: We evaluated data of 135 consecutive patients (mean age: 63 ± 15, 23.9% women) with LV anteroapical aneurysm who underwent SVR. Preoperative LV volumes and segmental wall motion abnormalities were assessed by CCT. Peak global and basal longitudinal strains were quantified for all patients by STE. Endpoints/events were defined as all-cause mortality, LV assist device implantation, or heart transplantation.

Results: During a median follow-up of 4.8 years (IQR: 1.4–7.9 years), events occurred in 55 patients (41%). Stratification according to tertiles of preoperative LVESVI revealed a significantly higher event-free survival rate in the lower tertile group (<80 mL/m²) than in the groups with a LVESVI of 80 to 121 mL/m² and >121 mL/m² (p = 0.039). An average 50-mL increase of preoperative LVESVI was associated with a 30% increase of the hazard of events (p = 0.043). Aneurysms limited to apical and antero-septal mid-ventricular LV segments were associated with a lower event risk in long-term follow-up (n = 49, HR: 0.43, CI: 0.23–0.82, p = 0.01). Those patients with LVESVI ≥80 mL/m² and scar extension beyond antero-apical region (with involvement of basal antero-septal segments of LV or/and any other region of LV) demonstrated higher probability of events (n = 71, HR: 1.58, 95% CI: 1.2–2.1, p = 0.003). In this group of patients, considered as a less favorable for SVR, basal peak longitudinal strain (BLS) ≤ −7.3% (higher deformation, cut-off defined in previous work [1]) was associated with better event-free survival in Kaplan–Meier analysis. Median event-free survival in patients with BLS ≤ −7.3% was 8.9 years (IQR: 5.9–11.8), whereas in patients with BLS > −7.3% median survival was only 1.6 years (IQR: 0–5.6), p = 0.009.

Conclusion: Patients with severely enlarged LV and scar extension beyond antero-apical region benefit less from SVR. Preserved BLS is associated with longer event-free survival and may be used to supplement the preoperative evaluation of these patients.

Publication History

Article published online:
28 January 2023