Pulsed tissue Doppler imaging detects early myocardial dysfunction in asymptomatic patients with severe mitral regurgitation

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 greater than or equal to 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 greater than or equal to 40 ms and Sm velocity less than or equal to10.5 cm/s was the main independent predictor of postoperative EF reduction greater than or equal to 10% ( sensitivity 78%, specificity 95%). Conclusions: TDI systolic indices can predict postoperative left ventricular function in patients with asymptomatic MR undergoing surgical correction.