Deceleration time in ischemic cardiomyopathy: Relation to echocardiographic and scintigraphic indices of myocardial viability and functional recovery after revascularization

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 (AEF) 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.