(Circulation. 2001;103:1232.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Deceleration Time in Ischemic Cardiomyopathy
Relation to Echocardiographic and Scintigraphic Indices of Myocardial Viability and Functional Recovery After Revascularization
From the Section of Cardiology, Department of Medicine (Y.Y., S.F.N., S.S., K.S., Z.-X.H., M.S.V., M.A.Q., W.A.Z.), and the Department of Surgery (M.J.R., G.V.L., J.F.H.), Baylor College of Medicine, Houston, Tex.
Correspondence and reprint requests to Sherif F. Nagueh, MD, 6550 Fannin St, SM-1246, Houston, Texas 77030-2717. E-mail sherifn{at}bcm.tmc.edu
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 201Tl 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 (
EF) after surgery
(r=0.77) (all
P<0.01). DT >150 ms
effectively identified (sensitivity 79%, specificity 81%) patients
with EF 
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.
Key Words: echocardiography • scintigraphy • cardiomyopathy • hibernation • diastole
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