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(Circulation. 1998;98:2098-2102.)
© 1998 American Heart Association, Inc.

Correspondence

Effects of Partial Left Ventriculectomy on Cardiac Performance

Kiyotaka Fukamachi, MD, PhD; Patrick M. McCarthy, MD; Randall C. Starling, MD; ; James B. Young, MD

Departments of Biomedical Engineering, Thoracic and Cardiovascular Surgery, and Cardiology, The Kaufman Center for Heart Failure, The Cleveland Clinic Foundation, Cleveland, Ohio

Response:

John Gorcsan, III, MD; ; Arthur M. Feldman, MD, PhD

Division of Cardiology

Anthony J. Demetris, MD

Division of Pathology

Robert L. Kormos, MD; ; William A. Mandarino, MS

Division of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa

Randas J.V. Batista, MD

Vilela Batista Foundation, Curitiba, Brazil

We acknowledge and thank Dr Fukamachi and colleagues for their comments regarding our report describing the immediate effects of partial left ventriculectomy (PLV) on cardiac performance in a group of 8 patients with severe heart failure.¹ This study used pressure-area relations by echocardiographic automated border detection as a surrogate for pressure-volume relations to assess ventricular function in a predominately load-independent manner. Estimates of end-systolic elastance (E_es) and preload recruitable stroke work demonstrated variable immediate results of PLV. Changes in E_es and preload recruitable stroke work were inversely correlated with semiquantitative histological measures of myocardial fibrosis and directly related to degrees of hypertrophy.

Although Fukamachi et al raise some interesting points regarding the analysis of E_es from our data, they did not account for the fact that we used cross-sectional area as a surrogate for ventricular volume to estimate ventricular performance. This explains the negative x-axis intercept values commonly encountered in pressure-area calculations of E_es because of the sharply curvilinear area-volume relationship in the low-volume range. Our group has previously validated this identical approach to calculate E_es as a predominantly load-insensitive index of contractility in animal models and in humans.^{2 3} Furthermore, 2 major findings support our results independently of the approach used to calculate E_es. First, similar results were found in estimates of preload recruitable stroke work that relate the integral of the entire pressure-area loop to end-diastolic area and eliminate the uncertainty of defining end systole.⁴ Second, our measures of alterations in ventricular performance after PLV were correlated significantly with the variability in myocardial fibrosis and hypertrophy by histological measures in these patients. Additional careful study is needed in a larger series of patients to further define the effects of this novel operation on cardiac performance and, more importantly, predict its related impact on patient outcome.

References

1. Gorcsan J, Feldman AM, Kormos RL, Mandarino WA, Demetris AJ, Batista RJV. Heterogeneous immediate effects of partial left ventriculectomy on cardiac performance. Circulation. 1998;97:839–842.[Abstract/Free Full Text]
   
2. Gorcsan J, Romand J, Mandarino WA, Deneault LG, Pinsky MR. Assessment of left ventricular performance by on-line pressure-area relations using echocardiographic automated border detection. J Am Coll Cardiol. 1994;23:242–252.
   
3. Gorcsan J, Gasior TA, Mandarino WA, Deneault LG, Hattler BG, Pinsky MR. Assessment of the immediate effects of cardiopulmonary bypass on left ventricular performance by on-line pressure-area relations. Circulation. 1994;89:180–190.[Abstract]
   
4. Glower DD, Spratt JA, Snow ND, Kabas JS, Davis JW, Olsen CO, Tyson GS, Sabiston DC, Rankin JS. Linearity of the Frank-Starling relationship in the intact heart: the concept of preload recruitable stroke work. Circulation. 1985;5:994–1009.[Abstract/Free Full Text]
   

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