Deceleration time in ischemic cardiomyopathy - Relation to echocardiographic and scintigraphic indices of myocardial viability and functional recovery after revascularization
Yq. Yong et al., Deceleration time in ischemic cardiomyopathy - Relation to echocardiographic and scintigraphic indices of myocardial viability and functional recovery after revascularization, CIRCULATION, 103(9), 2001, pp. 1232-1237
Citations number
25
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Background-In patients with heart failure secondary to left ventricular (LV
) systolic dysfunction, a short deceleration time (DT) successfully predict
s clinical outcome. The impact of myocardial viability and revascularizatio
n on the mitral inflow velocities, however, is unknown.
Methods and Results-Forty patients with ischemic cardiomyopathy underwent T
l-201 scintigraphy (SPECT) and 2D, Doppler, and dobutamine echocardiography
(DE, to 40 mug.kg(-1) min(-1)) 2 days before CABG. Echocardiography was re
peated 3 months after revascularization to determine recovery of function.
Significant correlations were present between DT and LV contractile reserve
by DE (r=0.72), scar perfusion defect by SPECT (r= -0.69), and the change
in ejection fraction (Delta EF) after surgery (r=0.77) (all P < 0.01). DT >
150 ms effectively identified (sensitivity 79%, specificity 81%) patients w
ith Delta EF greater than or equal to 5%. The population was divided into 2
groups according to DT: group 1 (DT >150 ms, n=21) and group 2 (DT less th
an or equal to 150 ms, n=19). At baseline, NYHA class, LV EF, age, and use
of cardiovascular drugs were similar between the 2 groups. The number of vi
able segments by both DE and SPECT, however, was higher in group 1 (both P
< 0.01), and only patients in group 1 had an increase in EF (29 +/- 4.8% to
40 +/- 8%, P<0.01) after surgery. Death and heart transplantation occurred
in 7 patients from group 2 and 1 patient from group 1 (P=0.017).
Conclusions-In patients with ischemic cardiomyopathy, the reduced amount of
viable myocardium results in a restrictive mitral inflow pattern, which in
turn predicts poor survival.