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Echocardiographic prediction of left ventricular function after correction of mitral regurgitation: results and clinical implications.
J Am Coll Cardiol. 1994 Nov 15; 24(6):1536-43.JACC

Abstract

OBJECTIVES

This study attempted to determine the incidence, prognosis and predictability of postoperative left ventricular dysfunction in patients undergoing correction of mitral regurgitation.

BACKGROUND

Left ventricular function in patients with mitral regurgitation is altered by loading conditions and is difficult to assess. Predictive value of preoperative variables on postoperative left ventricular function and the role of echocardiography are uncertain.

METHODS

In 266 patients undergoing correction of mitral regurgitation between 1980 and 1989, left ventricular function was echocardiographically assessed preoperatively (within 6 months) and postoperatively (within 1 year).

RESULTS

After correction of mitral regurgitation, left ventricular ejection fraction decreased significantly ([mean +/- SD] 50% +/- 14% vs. 58% +/- 13%, p < 0.0001). Postoperative left ventricular dysfunction (ejection fraction < 50%) was frequent (41% of patients) and carried a poor prognosis (at 8 years survival, 38% +/- 9% vs. 69% +/- 8%, p < 0.0001). Four preoperative echocardiographic variables showed good correlation with postoperative ejection fraction: preoperative ejection fraction (r = -0.70), systolic diameter (r = -0.63), diameter/thickness ratio (r = -0.64) and end-systolic wall stress (r = -0.62) (all p < 0.0001). With multivariate analysis, ejection fraction (p = 0.0001) and systolic diameter (p = 0.0005) were independent predictors of postoperative ejection fraction, and angiographic variables provided no incremental predictive power. In addition to echocardiographic variables, recent regurgitation, functional class and coronary artery disease were also independent predictors of postoperative ejection fraction.

CONCLUSIONS

After surgical correction of mitral regurgitation, left ventricular dysfunction is frequent and carries a poor prognosis. Postoperative ejection fraction can be predicted by echocardiographic preoperative ejection fraction and systolic diameter. Recent onset of regurgitation, mild or no symptoms, and absence of coronary artery disease are independent and favorable predictors of postoperative ejection fraction. These results should lead to consideration of surgical correction at an earlier stage.

Authors+Show Affiliations

Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

7930287

Citation

Enriquez-Sarano, M, et al. "Echocardiographic Prediction of Left Ventricular Function After Correction of Mitral Regurgitation: Results and Clinical Implications." Journal of the American College of Cardiology, vol. 24, no. 6, 1994, pp. 1536-43.
Enriquez-Sarano M, Tajik AJ, Schaff HV, et al. Echocardiographic prediction of left ventricular function after correction of mitral regurgitation: results and clinical implications. J Am Coll Cardiol. 1994;24(6):1536-43.
Enriquez-Sarano, M., Tajik, A. J., Schaff, H. V., Orszulak, T. A., McGoon, M. D., Bailey, K. R., & Frye, R. L. (1994). Echocardiographic prediction of left ventricular function after correction of mitral regurgitation: results and clinical implications. Journal of the American College of Cardiology, 24(6), 1536-43.
Enriquez-Sarano M, et al. Echocardiographic Prediction of Left Ventricular Function After Correction of Mitral Regurgitation: Results and Clinical Implications. J Am Coll Cardiol. 1994 Nov 15;24(6):1536-43. PubMed PMID: 7930287.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Echocardiographic prediction of left ventricular function after correction of mitral regurgitation: results and clinical implications. AU - Enriquez-Sarano,M, AU - Tajik,A J, AU - Schaff,H V, AU - Orszulak,T A, AU - McGoon,M D, AU - Bailey,K R, AU - Frye,R L, PY - 1994/11/15/pubmed PY - 1994/11/15/medline PY - 1994/11/15/entrez SP - 1536 EP - 43 JF - Journal of the American College of Cardiology JO - J Am Coll Cardiol VL - 24 IS - 6 N2 - OBJECTIVES: This study attempted to determine the incidence, prognosis and predictability of postoperative left ventricular dysfunction in patients undergoing correction of mitral regurgitation. BACKGROUND: Left ventricular function in patients with mitral regurgitation is altered by loading conditions and is difficult to assess. Predictive value of preoperative variables on postoperative left ventricular function and the role of echocardiography are uncertain. METHODS: In 266 patients undergoing correction of mitral regurgitation between 1980 and 1989, left ventricular function was echocardiographically assessed preoperatively (within 6 months) and postoperatively (within 1 year). RESULTS: After correction of mitral regurgitation, left ventricular ejection fraction decreased significantly ([mean +/- SD] 50% +/- 14% vs. 58% +/- 13%, p < 0.0001). Postoperative left ventricular dysfunction (ejection fraction < 50%) was frequent (41% of patients) and carried a poor prognosis (at 8 years survival, 38% +/- 9% vs. 69% +/- 8%, p < 0.0001). Four preoperative echocardiographic variables showed good correlation with postoperative ejection fraction: preoperative ejection fraction (r = -0.70), systolic diameter (r = -0.63), diameter/thickness ratio (r = -0.64) and end-systolic wall stress (r = -0.62) (all p < 0.0001). With multivariate analysis, ejection fraction (p = 0.0001) and systolic diameter (p = 0.0005) were independent predictors of postoperative ejection fraction, and angiographic variables provided no incremental predictive power. In addition to echocardiographic variables, recent regurgitation, functional class and coronary artery disease were also independent predictors of postoperative ejection fraction. CONCLUSIONS: After surgical correction of mitral regurgitation, left ventricular dysfunction is frequent and carries a poor prognosis. Postoperative ejection fraction can be predicted by echocardiographic preoperative ejection fraction and systolic diameter. Recent onset of regurgitation, mild or no symptoms, and absence of coronary artery disease are independent and favorable predictors of postoperative ejection fraction. These results should lead to consideration of surgical correction at an earlier stage. SN - 0735-1097 UR - https://www.unboundmedicine.com/medline/citation/7930287/Echocardiographic_prediction_of_left_ventricular_function_after_correction_of_mitral_regurgitation:_results_and_clinical_implications_ L2 - https://linkinghub.elsevier.com/retrieve/pii/0735-1097(94)90151-1 DB - PRIME DP - Unbound Medicine ER -