title: Novel Echocardiographic Indices as Predictors of Immediate Recurrence after Undersized Ring Annuloplasty for Ischemic Mitral Regurgitation.
abstract: OBJECTIVE
  Ischemic mitral regurgitation (IMR) is among the most serious complications of myocardial infarction which doubles the late mortality; mainly treated by undersizing ring annuloplasty. To find some preoperative echocardiographic indices that predict immediate failure of mitral valve annuloplasty (MVA), we designed the present study with more focusing on some novel parameters.
  
  
  METHODS
  Transthoracic echocardiography (TTE) indices of consecutive patients referred with 3+ or 4+ IMR were registered 24 hours before surgery. Thirty days later, a second TTE was performed. According to the results, the patients were categorized as the "successful" group (with 1+ or less mitral regurgitation) and the "unsuccessful" group (with 2+ or higher MR). Preoperative TTE indices were compared among the two groups using suitable statistical tests.
  
  
  RESULTS
  Of the total of 126 cases, 68 had successful and 58 had unsuccessful MVA. Statistically significant differences were found between the two groups for left ventricular ejection fraction (LVEF) (P = 0.007), left ventricular end systolic volume (LVESV) (P = 0.044), and basal-interpapillary muscle distance (IPMD) diastolic-to-systolic ratio (DSR) (P = 0.008). Receiver Operating Characteristic analysis demonstrated 37.5%, 3.85 cm(3) , and 1.25, as the best cutoff points for LVEF (P = 0.03, sensitivity: 81%, specificity: 69%), LVESV (P = 0.023, sensitivity: 83%, specificity: 57%), and basal-IPMD DSR (P = 0.001, sensitivity: 100%, specificity: 95%), respectively.
  
  
  CONCLUSIONS
  Among all TTE indices, LVEF, LVESV, and basal-IPMD DSR were helpful to differentiate between the successful and unsuccessful MVA results. We believe the basal-IPMD DSR as a novel index could be targeted in the future studies.
authors.affiliation: Department of Cardiology, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Shokoufeh
authors.initials: S
authors.lastname: Hajsadeghi
authors.affiliation: Department of Cardiology, Shahid Rajaee Heart Hospital, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Niloufar
authors.initials: N
authors.lastname: Samiee
authors.affiliation: Department of Cardiac Surgery, Heart Valve Research Center, Shahid Rajaee Heart Hospital, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Seyyed Saied
authors.initials: SS
authors.lastname: Hosseini
authors.affiliation: Department of Internal Medicine, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Morteza
authors.initials: M
authors.lastname: Hassanzadeh
authors.affiliation: Department of Cardiology, Student Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Scott Reza Jafarian
authors.initials: SR
authors.lastname: Kerman
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery; D058386:Mitral Valve Annuloplasty; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D012008:Recurrence; D016896:Treatment Outcome; D014463:Ultrasonography
keywords: echocardiography; immediate recurrence; ischemic mitral regurgitation; ring annuloplasty