Left ventricular volume predicts postoperative course in patients with ischemic cardiomyopathy

Background. The left ventricular end-systolic volume index (LVESVI) helps to predict postoperative left ventricular function in patients with ischemic cardiomyopathy. Methods. We retrospectively assessed the ability of preoperative variables to predict death and the development of postoperative congestive heart failure in 41 patients with a preoperative ejection fraction of less than 0.30. Results. A preoperative LVESVI of greater than 100 mL/m(2) was identified as an independent predictor of death by Cox's proportional hazards model. Diabetes and a preoperative LVESVI of greater than 100 mL/m(2) were independent predictive risk factors for the development of postoperative congestive heart failure. Postoperative congestive heart failure developed in 2 of the 23 patients (8.7%) who had a preoperative LVESVI of less than 100 mL/m(2) and in 10 of the 16 patients (62.5%) who had a preoperative LVESVI of greater than 100 mL/m(2). The actuarial survival rate during follow-up in patients who had a preoperative LVESVI of less than 100 mL/m(2) was significantly greater than that in patients who had a preoperative LVESVI of greater than 100 mL/m(2). The actuarial rate of freedom from congestive heart failure during the follow-up period also was greater in patients who had a preoperative LVESVI of less than 100 mL/m(2). Conclusions. Our results suggest that the preoperative LVESVI predicts the development of postoperative congestive heart failure and the actuarial survival rate in patients with ischemic cardiomyopathy. (C) 1998 by The Society of Thoracic Surgeons.