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Usefulness of preoperative atrial fibrillation to predict outcome and left ventricular dysfunction after valve repair for mitral valve prolapse.
Am J Cardiol 2015; 115(10):1448-53AJ

Abstract

The aim of the study was to assess the impact of atrial fibrillation (AF) on outcome in patients who underwent mitral valve repair (MVRp) for mitral valve prolapse (MVP). Four hundred and forty-three consecutive patients underwent MVRp for organic mitral regurgitation due to MVP. Echocardiography was performed preoperatively and after surgery. Postoperative left ventricular dysfunction (LVD) was defined as left ventricular ejection fraction (LVEF) <50%. Before surgery, 187 patients (42%) had preoperative AF. After surgery, LVEF significantly decreased from 67 ± 9% to 56 ± 10% (p <0.0001). Compared with patients in sinus rhythm (SR), those in AF were significantly older (p <0.0001), had more severe symptoms (p = 0.004), had lower LVEF (p = 0.002), and higher EuroSCORE (p = 0.05). Compared with patients in SR, patients with AF had significantly lower 10-year survival (64 ± 4% vs 83 ± 3%, p = 0.001). On multivariate analysis, preoperative AF was identified as an independent predictor of overall mortality (hazard ratio 1.67; 95% confidence interval 1.15 to 2.42; p = 0.007). At 10 years, patients with paroxysmal AF had lower survival and higher heart failure rate than patients in SR (78 ± 3% vs 66 ± 6%) but had a better outcome compared with those with permanent AF (66 ± 6% vs 53 ± 6%, p = 0.022). Patients with AF had a significantly higher rate of postoperative LVD (23.3% vs 13.4%, p = 0.007). In conclusion, preoperative AF is a predictor of long-term mortality and postoperative LVD after MVRp for MVP. To improve postoperative outcome, surgery in these patients should be performed before onset of AF.

Authors+Show Affiliations

Department of Cardiology, University Hospital Amiens, Amiens, France.Department of Cardiology, University of Liege, CHU Sart Tilman, Liège, Belgium.Department of Cardiology, University Hospital Amiens, Amiens, France.Department of Cardiology, University Hospital Amiens, Amiens, France.Department of Cardiac Surgery, University Hospital Amiens, Amiens, France.Department of Cardiology, University Hospital Amiens, Amiens, France; INSERM U1088, University of Picardie, Amiens, France. Electronic address: tribouilloy.christophe@chu-amiens.fr.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25784520

Citation

Szymanski, Catherine, et al. "Usefulness of Preoperative Atrial Fibrillation to Predict Outcome and Left Ventricular Dysfunction After Valve Repair for Mitral Valve Prolapse." The American Journal of Cardiology, vol. 115, no. 10, 2015, pp. 1448-53.
Szymanski C, Magne J, Fournier A, et al. Usefulness of preoperative atrial fibrillation to predict outcome and left ventricular dysfunction after valve repair for mitral valve prolapse. Am J Cardiol. 2015;115(10):1448-53.
Szymanski, C., Magne, J., Fournier, A., Rusinaru, D., Touati, G., & Tribouilloy, C. (2015). Usefulness of preoperative atrial fibrillation to predict outcome and left ventricular dysfunction after valve repair for mitral valve prolapse. The American Journal of Cardiology, 115(10), pp. 1448-53. doi:10.1016/j.amjcard.2015.02.027.
Szymanski C, et al. Usefulness of Preoperative Atrial Fibrillation to Predict Outcome and Left Ventricular Dysfunction After Valve Repair for Mitral Valve Prolapse. Am J Cardiol. 2015 May 15;115(10):1448-53. PubMed PMID: 25784520.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Usefulness of preoperative atrial fibrillation to predict outcome and left ventricular dysfunction after valve repair for mitral valve prolapse. AU - Szymanski,Catherine, AU - Magne,Julien, AU - Fournier,Alexandre, AU - Rusinaru,Dan, AU - Touati,Gilles, AU - Tribouilloy,Christophe, Y1 - 2015/02/18/ PY - 2014/12/27/received PY - 2015/02/13/revised PY - 2015/02/13/accepted PY - 2015/3/19/entrez PY - 2015/3/19/pubmed PY - 2015/7/8/medline SP - 1448 EP - 53 JF - The American journal of cardiology JO - Am. J. Cardiol. VL - 115 IS - 10 N2 - The aim of the study was to assess the impact of atrial fibrillation (AF) on outcome in patients who underwent mitral valve repair (MVRp) for mitral valve prolapse (MVP). Four hundred and forty-three consecutive patients underwent MVRp for organic mitral regurgitation due to MVP. Echocardiography was performed preoperatively and after surgery. Postoperative left ventricular dysfunction (LVD) was defined as left ventricular ejection fraction (LVEF) <50%. Before surgery, 187 patients (42%) had preoperative AF. After surgery, LVEF significantly decreased from 67 ± 9% to 56 ± 10% (p <0.0001). Compared with patients in sinus rhythm (SR), those in AF were significantly older (p <0.0001), had more severe symptoms (p = 0.004), had lower LVEF (p = 0.002), and higher EuroSCORE (p = 0.05). Compared with patients in SR, patients with AF had significantly lower 10-year survival (64 ± 4% vs 83 ± 3%, p = 0.001). On multivariate analysis, preoperative AF was identified as an independent predictor of overall mortality (hazard ratio 1.67; 95% confidence interval 1.15 to 2.42; p = 0.007). At 10 years, patients with paroxysmal AF had lower survival and higher heart failure rate than patients in SR (78 ± 3% vs 66 ± 6%) but had a better outcome compared with those with permanent AF (66 ± 6% vs 53 ± 6%, p = 0.022). Patients with AF had a significantly higher rate of postoperative LVD (23.3% vs 13.4%, p = 0.007). In conclusion, preoperative AF is a predictor of long-term mortality and postoperative LVD after MVRp for MVP. To improve postoperative outcome, surgery in these patients should be performed before onset of AF. SN - 1879-1913 UR - https://www.unboundmedicine.com/medline/citation/25784520/Usefulness_of_preoperative_atrial_fibrillation_to_predict_outcome_and_left_ventricular_dysfunction_after_valve_repair_for_mitral_valve_prolapse_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9149(15)00723-7 DB - PRIME DP - Unbound Medicine ER -