Left ventricular diastolic function after restrictive mitral ring annuloplasty in chronic ischemic mitral regurgitation and its predictive value on outcome and recurrence of regurgitation.
BACKGROUND
This study was aimed at exploring the predictive value of diastolic function on clinical outcome and recurrence of ischemic mitral regurgitation following combined undersized mitral annuloplasty (UMRA) and coronary artery bypass grafting (CABG).


METHODS
Two hundred-thirty-four patients with chronic ischemic mitral regurgitation (CIMR) who survived combined UMRA and CABG between September 2001 and September 2007, were divided into four groups on the basis of baseline deceleration time (DT) and systolic-diastolic pulmonary venous flow ratio (S/D): Group 1, normal (n=48), Group 2, impaired relaxation (n=61), Group 3, pseudonormal (n=60) and Group 4, restrictive (n=65). Echocardiograms were performed, preoperatively, at discharge and at follow-up appointments (early, 6 months [interquartile range, IQR] 3-8 months; late, 38 months [IQR17-53 months]).


RESULTS
Early mortality rate was highest in the restrictive group (9.2%, p<0.001). In addition 6-year actuarial survival was significantly lower in Group 4 (p=0.025). At late follow-up, among patients in Group 4, 58.4% (n=38) had an MR grade >or=2 (p<0.001). Furthermore, DT<140 ms and S/D<0.80 were independent predictors of early (p<0.001 and 0.004, respectively) and late (both p<0.001) death. Finally DT<140 ms was the only diastolic independent predictor of MR recurrence (p<0.001).


CONCLUSIONS
In patients with CIMR undergoing combined CABG and UMRA restrictive LV diastolic filling pattern is an important preoperative marker of high early and late death and recurrence of MR.
Gelsomino
Sandro
S
Cardiac Surgery Dept of Heart and Vessels, Experimental Surgery Unit, Careggi Hospital, Florence, Italy. sandro.gelsomino@libero.it
Lorusso
Roberto
R
Billè
Giuseppe
G
Rostagno
Carlo
C
De Cicco
Giuseppe
G
Romagnoli
Stefano
S
Porciani
Cristina
C
Tetta
Cecilia
C
Stefàno
Pierluigi
P
Gensini
Gian Franco
GF
D000368:Aged; D002908:Chronic Disease; D001026:Coronary Artery Bypass; D003971:Diastole / Q000502:physiology*; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D017202:Myocardial Ischemia / Q000150:complications* / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery; D011184:Postoperative Period; D012372:ROC Curve; D012008:Recurrence; D016019:Survival Analysis; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology; D020257:Ventricular Remodeling