title: Pulsed tissue Doppler imaging detects early myocardial dysfunction in asymptomatic patients with severe mitral regurgitation.
abstract: OBJECTIVE
  To assess whether tissue Doppler myocardial imaging (TDI) indices can predict postoperative left ventricular function in patients with mitral regurgitation (MR) after surgical correction.
  
  
  METHODS
  84 patients (mean (SD) age 54.3 (10.8) years) with asymptomatic severe MR, an end systolic diameter < 45 mm, and an ejection fraction (EF) > 60% were subdivided in two groups: 43 patients with a postoperative EF reduction < 10% (group 1) and 41 patients with a postoperative EF reduction > or = 10% (group 2).TDI systolic indices of the lateral annulus were analysed preoperatively to assess myocardial systolic wave (Sm) velocity, myocardial precontraction time (PCTm), myocardial contraction time (CTm), and the PCTm:CTm ratio.
  
  
  RESULTS
  Postoperative EF decreased significantly (from 67 (5)% to 60 (5.5)%, p = 0.0001). Group 2 had a higher PCTm, CTm, and PCTm:CTm ratio and a lower Sm velocity than group 1 (PCTm 100.4 (19) ms v 82 (21.8) ms, p = 0.004; CTm 222 (3.1) ms v 215 (2.3) ms, p = 0.01; PCTm:CTm 0.45 (0.08) v 0.38 (0.09), p = 0.001; Sm velocity 10.4 (1.1) cm/s v 13 (1.3) cm/s, p = 0.0001). Multivariate regression analysis showed that the combination of PCTm:CTm ratio > or = 40 ms and Sm velocity < or = 10.5 cm/s was the main independent predictor of postoperative EF reduction > or = 10% (sensitivity 78%, specificity 95%).
  
  
  CONCLUSIONS
  TDI systolic indices can predict postoperative left ventricular function in patients with asymptomatic MR undergoing surgical correction.
authors.affiliation: Division of Non-Invasive Cardiology, San Raffaele Hospital, IRCCS, Milan, Italy. agricola.eustachio@hsr.it
authors.forename: E
authors.initials: E
authors.lastname: Agricola
authors.forename: M
authors.initials: M
authors.lastname: Galderisi
authors.forename: M
authors.initials: M
authors.lastname: Oppizzi
authors.forename: A F L
authors.initials: AF
authors.lastname: Schinkel
authors.forename: F
authors.initials: F
authors.lastname: Maisano
authors.forename: M
authors.initials: M
authors.lastname: De Bonis
authors.forename: A
authors.initials: A
authors.lastname: Margonato
authors.forename: A
authors.initials: A
authors.lastname: Maseri
authors.forename: O
authors.initials: O
authors.lastname: Alfieri
mesh_terms: D009202:Cardiomyopathies / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003971:Diastole; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D013318:Stroke Volume / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology