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Abstract:

Aim: was to study influence of surgical reconstruction of left ventricular (LV) in patients with postinfarction LV aneurysm, on dynamics of stroke volume (SV) and determine basic predictors of its decreasement.

Materials and Methods: retrospective study included patients with various types of surgical reconstruction of post-infarction LV aneurysm who underwent cardiac MRI before surgery, and subsequent control study by the same method in the postoperative period (mean 17,6 ± 4,7 days ) from March 2010 to February 2014. For statistical analysis, patients were divided into 2 groups according to the postoperative increase or decrease of SV Performed statistical analysis of baseline and post-operative structure - geometric and functional parameters of LV A mathematical model, based on which the multivariate analysis was performed using an automated method of linear modeling tc identify the most important predictor of subsequent risk assessment and its impact on postoperative decrease SV

Results: the left ventricular reconstruction surgery in the early postoperative period leads to reduce of left ventricular end diastolic (LVED) and end-systolic volume (LVES), respectively 22,41% and 21,85% (p <0,001), and an increase in ejection fraction (EF) at 21,76% (p <0,001), that seemingly indicates improvement in the pumping function of the heart. But, however, pointed out that the stroke volume, which more accurately reflects the feature after reconstruction LV increases less than half of patients (42.6%), an average of 11,2±1,6%, (p <0,001) and the majority (57,4%) decreases in average 21,0 ± 1,6%. (p <0,001). Groups with a postoperative increase or decrease in the value of SV differed except its dynamics (p <0,001), for the volume reduction of LVES (p = 0.25) increase in EF (p <0,001), a decrease INLS (p = 0.006). Found that the most important predictor of postoperative dynamics affecting the SV is the surgical reduction of LV volume (LVED). With a decrease in LV volume more than 25% of the original LVED risk reduction SV becomes high (OR 0,53; 95% CI 0,35, 0,79). When surgical volume reduction ratio greater than 35% chance of postoperative improvement SV maximally reduced (RR 4,74; 95% CI 1,27; 17,73; p = 0,042).

Conclusion: after surgical reconstruction of postinfarction LV aneurysms in the early postoperative period increase SV occurs in less than half of patients (42.6%), despite an increase in ejection fraction and decreased LVED. Leading predictor of postoperative determining the dynamics of the SV, is surgical reduction of left ventricular volume. Reduction of the volume of the left ventricle during the operation of surgical correction of left ventricular aneurysm more than 25% of the original LVED increases the risk of postoperative decrease in stroke volume, and more than 35% reduces chances of his promotion. 

 

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