Deceleration Time in Ischemic Cardiomyopathy

Abstract

Background —In patients with heart failure secondary to left ventricular (LV) systolic dysfunction, a short deceleration time (DT) successfully predicts clinical outcome. The impact of myocardial viability and revascularization on the mitral inflow velocities, however, is unknown. Methods and Results —Forty patients with ischemic cardiomyopathy underwent 201 Tl scintigraphy (SPECT) and 2D, Doppler, and dobutamine echocardiography (DE, to 40 μg · kg −1 · min −1 ) 2 days before CABG. Echocardiography was repeated 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 (ΔEF) after surgery ( r =0.77) (all P <0.01). DT >150 ms effectively identified (sensitivity 79%, specificity 81%) patients with ΔEF ≥5%. The population was divided into 2 groups according to DT: group 1 (DT >150 ms, n=21) and group 2 (DT ≤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 viable 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.