title: Left ventricular basal myocardial scarring detected by delayed enhancement magnetic resonance imaging predicts outcomes after surgical therapies for patients with ischemic mitral regurgitation and left ventricular dysfunction.
abstract: BACKGROUND
  Treatment of heart failure by surgical procedures such as mitral annuloplasty and left ventricular (LV) restoration is increasingly applied to patients with ischemic mitral regurgitation (IMR) and LV dysfunction. The clinical efficacy of delayed enhancement magnetic resonance imaging (DE-MRI) was studied to predict LV functional recovery and adverse outcomes after these therapies.
  
  
  RESULTS
  In 26 patients with IMR and a LV ejection fraction < 40%, DE-MRI was performed before the operation and the percentage of regional myocardial scarring was quantified at the basal, mid, and apical LV. Calculated percentage of fibrosis was 12 ± 12% at the base, 24 ± 15% at the mid, and 35 ± 31% at the apical LV. The degree of basal fibrosis was a significant predictor of less improvement of LV ejection fraction and postoperative restrictive diastolic filling. A linear correlation was noted between basal fibrosis and postoperative ejection fraction (P = 0.001, R = -0.61), the early to late mitral valve flow ratio (P = 0.0005, R = 0.66), and deceleration time (P = 0.01, R = -0.51). Logistic regression analysis demonstrated that the percentage of basal fibrosis was the independent predictor of postoperative adverse clinical outcomes (odds ratio, 1.26; P = 0.04).
  
  
  CONCLUSIONS
  In patients undergoing surgical heart failure therapy for IMR, the extent of basal fibrosis characterized by DE-MRI might be a useful predictor of postoperative LV systolic and diastolic functional recovery and postoperative adverse outcomes.
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Takeda
authors.forename: Goro
authors.initials: G
authors.lastname: Matsumiya
authors.forename: Seiki
authors.initials: S
authors.lastname: Hamada
authors.forename: Taichi
authors.initials: T
authors.lastname: Sakaguchi
authors.forename: Shigeru
authors.initials: S
authors.lastname: Miyagawa
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamauchi
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Sawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D003287:Contrast Media; D004452:Echocardiography; D005260:Female; D005355:Fibrosis; D019786:Gadolinium DTPA; D006333:Heart Failure / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D007564:Japan; D016014:Linear Models; D016015:Logistic Models; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D058386:Mitral Valve Annuloplasty; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D017202:Myocardial Ischemia / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D009206:Myocardium / Q000473:pathology*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016277:Ventricular Function, Left
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA