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European Journal of Echocardiography Advance Access published online on March 11, 2008
European Journal of Echocardiography, doi:10.1093/ejechocard/jen034
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Prognostic value of Doppler-derived mitral deceleration time on left ventricular reverse remodelling after undersized mitral annuloplasty

Sandro Gelsomino1,*, Roberto Lorusso2, Carlo Rostagno1, Sabina Caciolli1, Giuseppe Billè1, Giuseppe De Cicco2, Stefano Romagnoli1, Cristina Porciani1, Pierluigi Stefàno1 and Gian Franco Gensini1

1 Experimental Surgery Unit, Cardiac Surgery, Department of Heart and Vessels, Careggi Hospital, Viale Morgagni 85, 50134 Florence, Italy
2 Cardiac Surgery Unit, Civic Hospital, Brescia, Italy

Received 15 October 2008; .

* Corresponding author. Tel: +39 055 794 7628; fax: +39 055 794 7467.E-mail address: sandro.gelsomino{at}libero.it


  Abstract

Aims: 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).

Methods and 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 ≤ 125 (P < 0.001) was a strong predictor of LVRR after annuloplasty.

Conclusion: 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.

Keywords: Mitral valve; Mitral regurgitation; Mitral valve repair


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