The Effects Of Percutaneous Ventricular Restoration On Cardiac Function And Left Ventricular Geometry

Background and objective: After the acute myocardial infarction(AMI),the myocardial necrosis occurred in left ventricle,culminating in compensatory changes of myocardium structure,ventricular wall thickness and volume.Those pathophysiological processes are called left ventricular remodeling,which is closely related to heart failure(HF).Percutaneous ventricular restoration(PVR)is a treatment to reduce ventricular volume and also restore the geometric construction.This first-in-man study aimed to determine the safety and efficacy of left ventricular partitioning device(LVPD)in patients with chronic heart failure and ventricular aneurysm post myocardial infarction,and to analyze the effects of PVR on ventricular geometry,wall stress and motion.Methods: Sixteen patients were enrolled and underwent PVR procedures with implantation of LVPD.Immediate success rate and major adverse cardiovascular and cerebrovascular events(MACCEs)including all-cause mortality,myocardial infarction,stroke,emergent or selective surgery or interventional therapy,renal failure requiring hemodialysis and major bleeding were recorded.Efficacy features included functional status,echocardiographic characteristics,life quality characteristics at baseline and during followup.Comparation of pre and 12 months post-PVR contrast-enhanced CT images from 8subjects,including left ventricular geometry,ventricular wall stress,as well as wall motion analysis through point cloud registration technology were conducted.Results: The device immediate success rate was 93.75%.During follow up of 12 months,1 MACCE was found.The left ventricular end-systolic volume index decreased significantly(LVESVI,72.47±22.77 m L/m2 vs.48.30±21.11 m L/m2,p<0.001),as did left ventricular end diastolic volume index(LVEDVI,106.29±28.01 m L/m2 vs.79.90±26.98 m L/m2,p<0.001).Left ventricular ejection fraction(LVEF,32.47±6.98% vs.42.30±8.53%,p<0.05),6-min walk test(383.13±108.70 m vs.491.17±118.44 m,p<0.001)and European five-dimensional health scale(EQ-5D,65.93±11.25 vs.82.50±5.44,p<0.001)improved significantly.The improvement of geometrical morphology after PVR depending upon anatomical difference.The systolic wall stress decreased significantly in 7 out of 8 cases.The LVPD also improved the global wall motion and eliminated the negative effects of ventricular aneurysm.Conclusions: LVPD appeared to be safe and effective for treatment of HF postmyocardial infarction,and can improve the geometrical morphology and wall motion,relief the wall stress.