Key result
Baseline restrictive mitral deceleration time (DT ≤ 125 ms) strongly predicted the absence of left ventricular reverse remodelling after annuloplasty (0% vs 88.3-96.3% in other groups; P<0.001).
Why the study?
Does baseline Doppler-derived mitral deceleration time predict left ventricular reverse remodelling in patients with chronic ischaemic mitral regurgitation undergoing combined UMRA and CABG?
Cohort (n=215)
No
Does baseline Doppler-derived mitral deceleration time predict left ventricular reverse remodelling in patients with chronic ischaemic mitral regurgitation undergoing combined UMRA and CABG?
Pre-operative restrictive mitral deceleration time (DT <= 125 ms) strongly predicts the absence of left ventricular reverse remodelling after undersized mitral annuloplasty for chronic ischaemic mitral regurgitation.
Restrictive mitral DT may identify annuloplasty non-responders in ischaemic MR; hypothesis-generating and requires prospective validation before guiding selection.
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 <or= 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.
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Gelsomino et al. (2008) conducted a cohort in Chronic ischaemic mitral regurgitation (CIMR) (n=215). Baseline Doppler-Derived Mitral Deceleration Time (DT) vs. Different baseline DT groups (normal, impaired relaxation, pseudonormal, restrictive) was evaluated on Left ventricular reverse remodelling (LVRR), defined as a reduction in ESV > 15% (p=<0.001). Baseline restrictive mitral deceleration time (DT ≤ 125 ms) strongly predicted the absence of left ventricular reverse remodelling after annuloplasty (0% vs 88.3-96.3% in other groups; P<0.001).
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