title: Left ventricular dyssynchrony is associated with recurrence of ischemic mitral regurgitation after restrictive annuloplasty.
abstract: BACKGROUND
  In our study, we investigated the impact of papillary muscle systolic dyssynchrony (DYS-PAP) obtained by 2D speckle-tracking echocardiography (2D-STE) in the prediction of recurrent ischemic mitral regurgitation (MR) after restrictive annuloplasty.
  
  
  METHODS
  The study population consisted of 524 consecutive patients who survived coronary artery bypass grafting (CABG) and restrictive annuloplasty, performed between 2001 and 2010 at 3 different Institutions and who met inclusion criteria. The assessment of DYS-PAP was performed preoperatively and at follow-up (median 45.3 months [IQR 26-67]) by 2D-STE in the apical four-chamber view for the anterolateral papillary muscle (ALPM) and apical long-axis view for the posteromedial papillary muscle (PMPM).
  
  
  RESULTS
  Recurrence of MR (≥ 2+ in patients with no/trivial MR at discharge) was found in 112 patients (21.3%) at follow-up. Compared to patients without recurrence of MR, these patients had higher DYS-PAP values at baseline (60.6 ± 4.4 ms vs. 47.2 ± 2.9 ms, p<0.001) which significantly worsened at follow-up (74.4 ± 5.2 ms, p=0.002 vs. baseline). In contrast, in patients with no MR recurrence, DYS-PAP was significantly reduced (25.3 ± 4.4 ms, p=0.002 vs. baseline). At logistic regression analysis DYS-PAP (odds ratio [OR]: 4.8, 95% Confidence Interval [CI]: 3.4-8.2, p<0.001), was the strongest predictor of recurrent MR with a cutoff ≥ 58 ms (95%CI 51-66 ms). The model showed an area under the Receiver Operating Characteristic (ROC) curve of 0.97 (CI 0.94-0.99 [optimism-corrected 0.94; CI 0.89-0.95]) with 98% sensitivity (CI 96-100% [optimism-corrected 95%; CI 91-96%]) and 90% specificity (CI 85-94% [optimism-corrected 87%; CI 82-90%]).
  
  
  CONCLUSIONS
  DYS-PAP represents a reliable tool to identify patients with ischemic MR who can benefit from restrictive annuloplasty.
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital, Maastricht, The Netherlands.
authors.forename: Leen
authors.initials: L
authors.lastname: van Garsse
authors.forename: Sandro
authors.initials: S
authors.lastname: Gelsomino
authors.forename: Fabiana
authors.initials: F
authors.lastname: Lucà
authors.forename: Orlando
authors.initials: O
authors.lastname: Parise
authors.forename: Roberto
authors.initials: R
authors.lastname: Lorusso
authors.forename: Emile
authors.initials: E
authors.lastname: Cheriex
authors.forename: Sabina
authors.initials: S
authors.lastname: Caciolli
authors.forename: Enrico
authors.initials: E
authors.lastname: Vizzardi
authors.forename: Carmelo Massimiliano
authors.initials: CM
authors.lastname: Rao
authors.forename: Rocco
authors.initials: R
authors.lastname: Carella
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Gensini
authors.forename: Jos
authors.initials: J
authors.lastname: Maessen
mesh_terms: D000368:Aged; D058385:Cardiac Valve Annuloplasty / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000601:surgery; D012008:Recurrence; D016896:Treatment Outcome; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000453:epidemiology*