Prognostic value of Doppler-derived mitral deceleration time on left ventricular reverse remodelling after undersized mitral annuloplasty.
OBJECTIVE
This study was aimed at exploring the predictive value of Doppler-Derived Mitral Deceleration Time (DT) on left ventricular reverse remodelling (LVRR) in patients with chronic ischaemic mitral regurgitation (CIMR) undergoing combined undersized mitral annuloplasty (UMRA) and coronary artery bypass grafting (CABG).


RESULTS
Two hundred and fifteen patients undergoing combined UMRA and CABG for CIMR between September 2001 and September 2007 in our Institution were divided into four groups on the basis of baseline DT: Group 1, normal (n = 48), Group 2, impaired relaxation (n = 61), Group 3, pseudonormal (n = 50), and Group 4, restrictive (n = 56). Echocardiograms were performed, pre-operatively, at discharge and at follow-up appointments (100% complete, early, median 6 months [interquartile range 4-8 months]) and late, median 38 months (17-61 months). Left ventricular reverse remodelling, defined as a reduction in ESV > 15%, occurred in 95.7, 96.3, 88.3, and 0% in Groups 1, 2, 3, and 4, respectively (P < 0.001). Logistic regression analysis showed that DT <or= 125 (P < 0.001) was a strong predictor of LVRR after annuloplasty.


CONCLUSIONS
Pre-operative assessment of DT adds significant information to commonly used indexes of global and regional function, and represent a very easy and cost-effective tool to accurately identify CIMR patients who can really benefit from annuloplasty.
Gelsomino
Sandro
S
Department of Heart and Vessels, Experimental Surgery Unit, Cardiac Surgery, Careggi Hospital, Viale Morgagni 85, 50134 Florence, Italy. sandro.gelsomino@libero.it
Lorusso
Roberto
R
Rostagno
Carlo
C
Caciolli
Sabina
S
Billè
Giuseppe
G
De Cicco
Giuseppe
G
Romagnoli
Stefano
S
Porciani
Cristina
C
Stefàno
Pierluigi
P
Gensini
Gian Franco
GF
D000368:Aged; D001026:Coronary Artery Bypass; D015150:Echocardiography, Doppler; D017548:Echocardiography, Transesophageal; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D016015:Logistic Models; D008297:Male; D008943:Mitral Valve / Q000473:pathology / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011379:Prognosis; D013318:Stroke Volume; D013995:Time; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D020257:Ventricular Remodeling