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Pulsed tissue Doppler imaging detects early myocardial dysfunction in asymptomatic patients with severe mitral regurgitation
  1. E Agricola1,
  2. M Galderisi2,
  3. M Oppizzi1,
  4. A F L Schinkel3,
  5. F Maisano4,
  6. M De Bonis4,
  7. A Margonato1,
  8. A Maseri5,
  9. O Alfieri4
  1. 1Division of Non-Invasive Cardiology, San Raffaele Hospital, IRCCS, Milan, Italy
  2. 2Department of Clinical and Experimental Medicine, Federico II University of Naples, Naples, Italy
  3. 3Department of Cardiology, Thoraxcentre, Erasmus MC, Rotterdam, Netherlands
  4. 4Division of Cardiac Surgery, San Raffaele Hospital, IRCCS, Milan, Italy
  5. 5Vita e Salute University, San Raffaele, Milan, Italy
  1. Correspondence to:
    Dr E Agricola
    Cardiologia Diagnostica Non-Invasiva, Ospedale San Raffaele, IRCCS, Via Olgettina 60, 20132 Milan, Italy;


Objective: To assess whether tissue Doppler myocardial imaging (TDI) indices can predict postoperative left ventricular function in patients with mitral regurgitation (MR) after surgical correction.

Methods: 84 patients (mean (SD) age 54.3 (10.8) years) with asymptomatic severe MR, an end systolic diameter < 45 mm, and an ejection fraction (EF) > 60% were subdivided in two groups: 43 patients with a postoperative EF reduction < 10% (group 1) and 41 patients with a postoperative EF reduction ⩾ 10% (group 2).TDI systolic indices of the lateral annulus were analysed preoperatively to assess myocardial systolic wave (Sm) velocity, myocardial precontraction time (PCTm), myocardial contraction time (CTm), and the PCTm:CTm ratio.

Results: Postoperative EF decreased significantly (from 67 (5)% to 60 (5.5)%, p  =  0.0001). Group 2 had a higher PCTm, CTm, and PCTm:CTm ratio and a lower Sm velocity than group 1 (PCTm 100.4 (19) ms v 82 (21.8) ms, p  =  0.004; CTm 222 (3.1) ms v 215 (2.3) ms, p  =  0.01; PCTm:CTm 0.45 (0.08) v 0.38 (0.09), p  =  0.001; Sm velocity 10.4 (1.1) cm/s v 13 (1.3) cm/s, p  =  0.0001). Multivariate regression analysis showed that the combination of PCTm:CTm ratio ⩾ 40 ms and Sm velocity ⩽ 10.5 cm/s was the main independent predictor of postoperative EF reduction ⩾ 10% (sensitivity 78%, specificity 95%).

Conclusions: TDI systolic indices can predict postoperative left ventricular function in patients with asymptomatic MR undergoing surgical correction.

  • tissue Doppler imaging
  • mitral regurgitation
  • left ventricular function
  • Am, myocardial atrial contraction
  • CTm, myocardial contraction time
  • EF, ejection fraction
  • Em, myocardial early contraction
  • LV, left ventricular
  • MR, mitral regurgitation
  • PCTm, myocardial precontraction time
  • Sm, myocardial systolic wave
  • TDI, tissue Doppler myocardial imaging

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