title: Detection of left ventricular dysfunction using early diastolic mitral annular velocity in patients undergoing mitral valve repair for mitral regurgitation.
abstract: OBJECTIVE
  Ejection fraction (EF) is considered an unreliable index in patients with mitral regurgitation (MR). Left ventricular dysfunction (LVD) frequently occurs after mitral valve repair (MVR), with the incidence being 15% to 34%. This study aimed at investigating whether preoperative early diastolic mitral annular velocity (E') is associated with LVD after MVR.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Sixty-three patients undergoing MVR for severe MR.
  
  
  METHODS
  None.
  
  
  RESULTS
  LVD was defined by a postoperative EF of<50%. Receiver operating characteristic (ROC) analysis and separate multivariate logistic regression models were used to examine the independent effects of echocardiographic variables on LVD risk. LVD occurred in 20 patients (31.7%). E' was correlated significantly with perioperative EF change (p = 0.019, r = 0.293). The area under the ROC curve was 0.777 (95% confidence interval [CI]: 0.644-0.911) for E', and the optimal threshold value of E' for predicting LVD was 6.5 cm/s (sensitivity, 80%; specificity, 67.4%). The frequency of LVD was 33.3% for a preoperative EF< 65%; 44.4% for preoperative EF< 65% and left ventricular end-systolic diameter>32 mm; and 88.9% for preoperative EF< 65%, left ventricular end-systolic diameter>32 mm, and E'< 6.5 cm/s (p = 0.006). Multivariate logistic regression models analysis revealed that E' was an independent risk factor for LVD (odds ratio: 1.98, 95% CI: 1.22-3.22).
  
  
  CONCLUSIONS
  Preoperative E' value was an independent risk factor of LVD after mitral valve repair in patients with severe MR.
authors.affiliation: Department of Anesthesiology, Osaka City University Graduate School of Medicine, Osaka, Japan. Electronic address: suehirokoichi@yahoo.co.jp.
authors.forename: Koichi
authors.initials: K
authors.lastname: Suehiro
authors.affiliation: Department of Anesthesiology, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Katsuaki
authors.initials: K
authors.lastname: Tanaka
authors.affiliation: Department of Anesthesiology, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Matsuura
authors.affiliation: Department of Anesthesiology, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Funao
authors.affiliation: Department of Anesthesiology, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Tokuhiro
authors.initials: T
authors.lastname: Yamada
authors.affiliation: Department of Anesthesiology, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Mori
authors.affiliation: Department of Anesthesiology, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Kiyonobu
authors.initials: K
authors.lastname: Nishikawa
mesh_terms: D000368:Aged; D003971:Diastole / Q000502:physiology*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D012372:ROC Curve; D012189:Retrospective Studies; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis*
keywords: early diastolic mitral annular velocity; left ventricular dysfunction; mitral regurgitation; mitral valve repair