Left Ventricular Contractile Entropy in 99mTc-Sestamibi SPECT is a Novel Prognostic Predictor in Patients with Non-ischemic Dilated Cardiomyopathy

Background: Although some patients with non-ischemic dilated cardiomyopathy (NIDCM) received mitral valve (MV) surgery show deterioration of cardiac function or poor prognosis after surgery, how to select appropriate patients for this treatment have still been under discussion. We investigated which parameters predict early and mid-term outcome after surgery in advanced NIDCM with mitral regurgitation (MR). Methods: From September 2005 to April 2014, 27 NIDCM (LVEF!35%) with MR underwent MV surgery, 15 repair and 12 replacement. Preand postoperative echocardiography and right heart catherterization were done and postoperative outcome were analyzed. Results:Mean follow-up duration was 25624 months. Three hospital deaths and 2 left ventricular assist device (LVAD) implantations occurred during hospitalization. Three-year freedom from MACE was 46.8%. NYHA functional class significantly improved (3.360.6 to 2.260.6, p!0.0001), LVESVI (158640 to 134639 ml/m, p!0.001) and pulmonary vascular resistance (PVR) (2136137 to 149679 dynes/s/cm, p!0.04) significantly decreased, and LV stroke work index (LVSWI) (20.767.0 to 23.9864.8 mmHg mL/m) modestly increased after surgery. Preoperative low LVSWI and high PVR were significant predictors for hospital mortality and LVAD implantation (p!0.0001, p50.04, respectively) and early and midterm MACE (p!0.02, p!0.02, respectively). Conclusions: MV surgery can improve early postoperative functional status and cardiac function in selected patients with advanced NIDCM. Preoperative LVSWI and PVR can be helpful to decide indication of MV surgery and predict postoperative clinical outcome.