Abstract 4289: Preoperative Detection of Left Ventricular Dysfunction by Doppler Time Analysis Including Tei Index in Normal Ejection Fraction Patients with Mitral Regurgitation
Ejection fraction (EF) is not considered to be a reliable parameter of left ventricular (LV) function in patients with mitral regurgitation (MR) and remains normal in most MR patients, while LV dysfunction expressed as reduced EF is often revealed after mitral valve repair. This study sought to examine the usefulness of Doppler time analysis including Tei index for detection of LV dysfunction in patients with MR and normal EF. We investigated 108 patients with apparently normal EF (EF ≥ 50%) and chronic MR who underwent uncomplicated mitral valve repair. Preoperative Tei index, ejection time, isovolumic contraction time (ICT), and isovolumic relaxation time (IRT) were measured by Doppler echo as previously reported. Pre- and postoperative EFs were calculated by modified Simpson’s method. EF was significantly decreased after surgery and LV dysfunction (EF < 50%) was revealed in 37 patients. Preoperative Tei index, ejection time, and ICT were significantly correlated with post-operative EF in all patients (r= −0.64, 0.54, −0.67, p<0.0001, respectively) and asymptomatic patients (n=44, r= −0.57, 0.50, −0.61, p<0.001). IRT was not significantly correlated with postoperative EF in every group. By setting pre-operative Tei index > 0.50 to predict post-operative EF <50%, this index had sensitivity, specificity, and accuracy of 89, 85, and 86% in all patients and 80%, 85%, and 84% in asymptomatic patients respectively. Pre-operative Tei index > 0.5 allows prediction of post-operative LV dysfunction in MR patients with an apparently normal EF. Thus, earlier surgery is recommended in asymptomatic MR patients with normal EF but Tei index > 0.5.