Deceleration time in ischemic cardiomyopathy: relation to echocardiographic and scintigraphic indices of myocardial viability and functional recovery after revascularization.
BACKGROUND
In patients with heart failure secondary to left ventricular (LV) systolic dysfunction, a short deceleration time (DT) successfully predicts clinical outcome. The impact of myocardial viability and revascularization on the mitral inflow velocities, however, is unknown.


RESULTS
Forty patients with ischemic cardiomyopathy underwent (201)Tl scintigraphy (SPECT) and 2D, Doppler, and dobutamine echocardiography (DE, to 40 microg. kg(-1). min(-1)) 2 days before CABG. Echocardiography was repeated 3 months after revascularization to determine recovery of function. Significant correlations were present between DT and LV contractile reserve by DE (r=0.72), scar perfusion defect by SPECT (r=-0.69), and the change in ejection fraction (DeltaEF) after surgery (r=0.77) (all P:<0.01). DT >150 ms effectively identified (sensitivity 79%, specificity 81%) patients with DeltaEF >/=5%. The population was divided into 2 groups according to DT: group 1 (DT >150 ms, n=21) and group 2 (DT </=150 ms, n=19). At baseline, NYHA class, LV EF, age, and use of cardiovascular drugs were similar between the 2 groups. The number of viable segments by both DE and SPECT, however, was higher in group 1 (both P:<0.01), and only patients in group 1 had an increase in EF (29+/-4.8% to 40+/-8%, P:<0.01) after surgery. Death and heart transplantation occurred in 7 patients from group 2 and 1 patient from group 1 (P:=0.017).


CONCLUSIONS
In patients with ischemic cardiomyopathy, the reduced amount of viable myocardium results in a restrictive mitral inflow pattern, which in turn predicts poor survival.
Yong
Y
Y
Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
Nagueh
S F
SF
Shimoni
S
S
Shan
K
K
He
Z X
ZX
Reardon
M J
MJ
Letsou
G V
GV
Howell
J F
JF
Verani
M S
MS
Quiñones
M A
MA
Zoghbi
W A
WA
D000704:Analysis of Variance; D001783:Blood Flow Velocity; D009202:Cardiomyopathies / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D001026:Coronary Artery Bypass; D015150:Echocardiography, Doppler; D006801:Humans; D008943:Mitral Valve / Q000502:physiology; D009204:Myocardial Revascularization; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000503:physiopathology*; D016276:Ventricular Function