Mitral valve repair is superior to valve replacement for the early preservation of cardiac function: relation of ventricular geometry to function

The immediate effect or mitral valve repair (MVP) or replacement (MVR) on cardiac function was compared in patients with mitral regurgitation in relation to the changes in left ventricular (LV) function and geometry by using intraoperative transesophageal echocardiography in 29 patients with MVP and 21 patients with MVR, before and immediately after cardiopulmonary bypass. The LV volumes, ejection fraction, and long-axis and short-axis lengths and eccentricity index (ratio of long axis to short axis) at end-systole and end-diastole were measured. After both MVP and MVR, there were significant decreases in LV end-diastolic volume (p < 0.0001). However, the ejection fraction did not change after MVP, whereas it decreased after MVR (p < 0.0001). After MVP, there was an increase in eccentricity index at end-systole (p < 0.0001). After MVR, there was no decrease in end-systolic volume, and the eccentricity index was lower than that after MVP (p < 0.0001). The change in LV ejection fraction correlated with the changes in eccentricity index at end-systole (r = 0.55; p < 0.0001) and end-diastole (r = 0.42; p < 0.0003). Immediate intraoperative LV function is preserved after MVP but is depressed after MVR for mitral regurgitation. The changes in ejection fraction correlate with changes in ventricular geometry.

Prognostic value of adenosine single-photon emission computed tomographic thallium imaging in medically treated patients with angiographic evidence of coronary artery disease

BACKGROUND

This study examined the prognostic value of adenosine single-photon emission computed tomographic thallium imaging in medically treated patients with angiographic evidence of coronary artery disease (CAD).

METHODS AND RESULTS

Patients who underwent coronary revascularization within 3 months of this study were excluded. There were 177 patients aged 64 +/- 11 years; 74 had one-vessel, 57 had two-vessel, and 46 had three-vessel CAD (> or = 50% diameter stenosis). During a mean follow-up of 22 +/- 13 months, there were 14 events (cardiac death or nonfatal myocardial infarction). Cox survival analysis with important clinical, catheterization, and scintigraphic variables identified the size of perfusion abnormality as the strongest predictor of events (chi 2 = 9). Life-table analysis showed that patients with perfusion defects of 15% or greater of the myocardium had a worse prognosis than had patients with no or smaller defects (Mantel-Cox statistic = 13; p < 0.001).

CONCLUSIONS

Thus adenosine single-photo emission computed tomographic thallium imaging provides important prognostic data in medically treated patients with CAD. The extent of thallium abnormality is the most important predictor of events.