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Tissue Doppler Imaging Predicts Left Ventricular Reverse Remodeling After Surgery for Mitral Regurgitation

 Young Song  ;  Sak Lee  ;  Young-Lan Kwak  ;  Chi-Young Shim  ;  Byung-Chul Chang  ;  Jae-Kwang Shim 
 ANNALS OF THORACIC SURGERY, Vol.96(6) : 2109-2115, 2013 
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Disease Progression ; Echocardiography, Doppler/methods* ; Female ; Follow-Up Studies ; Heart Ventricles/diagnostic imaging* ; Heart Ventricles/physiopathology ; Humans ; Male ; Middle Aged ; Mitral Valve/diagnostic imaging* ; Mitral Valve/physiopathology ; Mitral Valve Insufficiency/complications ; Mitral Valve Insufficiency/diagnostic imaging ; Mitral Valve Insufficiency/surgery* ; Postoperative Period ; Predictive Value of Tests ; Prognosis ; ROC Curve ; Retrospective Studies ; Ventricular Dysfunction, Left/diagnostic imaging* ; Ventricular Dysfunction, Left/etiology ; Ventricular Dysfunction, Left/physiopathology ; Ventricular Function, Left/physiology* ; Ventricular Remodeling*
BACKGROUND: Tissue Doppler imaging of systolic mitral annular velocity (Sm) has been shown to be able to detect early left ventricular (LV) dysfunction in the presence of chronic severe mitral regurgitation with normal left ventricular ejection fraction. We investigated the association of preoperative Sm with LV reverse remodeling after mitral valve surgery. METHODS: Patients with chronic severe organic mitral regurgitation exhibiting LV ejection fraction greater than 60% were enrolled. The LV reverse remodeling was defined as changes of LV mass index of 20% or greater postoperatively. The primary endpoints were to compare the changes of LV mass index in relation to the tertile distribution of the Sm and evaluate predictive value of the Sm for LV reverse remodeling. RESULTS: In all, 169 patients were analyzed. The changes of LV mass index in the first tertile was 25% (11% to 37) compared with 34% (19% to 43%) in the second tertile and 34% (26% to 47%) in the third tertile (p = 0.003). On multivariate analysis, Sm was the only independent predictor of LV reverse remodeling (odds ratio 1.77, 95% confidence interval: 1.30 to 2.40, p < 0.001). The optimal cutoff value measured by receiver-operating characteristic curve analysis was 7 cm/s of Sm (area under the curve 0.721, 95% confidence interval: 0.64 to 0.80, p < 0.001). CONCLUSIONS: In patients with severe mitral regurgitation exhibiting LV ejection fraction greater than 60%, surgery may be considered before the Sm is decreased below 7 cm/s to achieve favorable LV reverse remodeling.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kwak, Young Lan(곽영란) ORCID logo https://orcid.org/0000-0002-2984-9927
Song, Young(송영) ORCID logo https://orcid.org/0000-0003-4597-387X
Shim, Jae Kwang(심재광) ORCID logo https://orcid.org/0000-0001-9093-9692
Shim, Chi Young(심지영) ORCID logo https://orcid.org/0000-0002-6136-0136
Lee, Sak(이삭) ORCID logo https://orcid.org/0000-0001-6130-2342
Chang, Byung Chul(장병철)
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