Predictors of the deterioration of left ventricular systolic function after surgical intervention in severe primary mitral insufficiency: one-center prospective study
Article Sidebar
Main Article Content
Abstract
The aim – to verify whether the proposed new echocardiographic parameter of left ventricular (LV) systolic function – so-called effective LV ejection fraction – may become a predictor of occurrence of LV dysfunction in patients with severe primary mitral regurgitation (MR) after mitral valve surgery.
Material and methods. We performed prospective, one-center study and analysed the results of surgical treatment of 72 patients with severe primary MR (mitral valve replacement or repair) in the cardiac surgery department from October 2013 to February 2016. Transthoracic echocardiography was used to evaluate different parameters of LV systolic function, including the new parameter – effective LV ejection fraction. The measurement of parameters was performed three times: before the surgery, during the 1st week and during the 3rd month after surgery.
Results. Three patients died after the surgery. By applying the diagnostic coefficients (method of Wild – Hubler – Henkin) we determined the threshold point for effective LV ejection fraction, discriminating patients with deterioration of LV systolic function after surgery. We showed that the optimal threshold level was 30 % and the lower level was associated with sensitivity 80 %, specificity 94.4 %, odds ratio 68.0 (95 % confidence interval 10.6–261.7) for prognosis of ejection fraction reduction after surgery.
Conclusion. The parameter of effective LV ejection fraction may be used in patients with severe primary MR in order to predict the risk of LV ejection fraction deterioration after corrective surgery. This parameter might also be helpful for dynamic evaluation of these patients and to determine the terms of corrective mitral valve surgery before occurrence of irreversible LV dysfunction.
Article Details
Keywords:
References
Павлюк В.І., Жарінов О.Й., Чубучний В.М. та ін. Новий метод ехокардіографічної оцінки фракції викиду та обґрунтування застосування каптоприлу у хворих з гострим інфарктом міокарда // Укр. кардіол. журн.– 1997.– № 4.– С. 8–10.
Павлюк В.І., Мишаківський О.А., Жарінов О.Й. Ехокардіографічні методи оцінки систолічної функції та функціональних резервів лівого шлуночка в пацієнтів з тяжкою мітральною недостатністю // Кардіохірургія та інтервенційна кардіологія.– 2013.– № 3.– С. 58–66.
ACC/AHA guidelines for the management of patients with valvular heart disease. A report of the American College of Cardiology/American Heart Association. Task Force on Practice Guidelines (Committee on Management of Patients with Valvular Heart Disease) // J. Am. Coll. Cardiol.– 1998.– Vol. 32.– P. 1486–1588.
Armstrong W.F., Ryan T., Feigenbaum H. Feigenbaum’s Echocardiography.– Philadelphia: Lippincott Williams & Wilkins, 2010.– 785 p.
Chan V., Ruel M., Elmistekawy E. et al. Determinants of left ventricular dysfunction after repair of chronic asymptomatic mitral regurgitation // Ann. Thorac. Surg.– 2015.– Vol. 99.– P. 38–42.
Coutinho G.F., Garcia A.L., Correia P.M. et al. Long-term
follow-up of asymptomatic or mildly symptomatic patients with severe degenerative mitral regurgitation and preserved left ventricular function // J. Thorac. Cardiovasc. Surg.– 2014.– Vol. 148 (6).– P. 2795–2801.
Crawford M., Souchek J., Oprian C.A. et al. Determinants of survival and left ventricular performance after mitral valve replacement // Circulation.– 1990.– Vol. 81.– P. 1173–1181.
Detaint D., Sundt T.M., Nkomo V.T. et al. Surgical correction of mitral regurgitation in the elderly: Outcomes and recent improvements // Circulation.– 2006.– Vol. 114.– Р. 265–272.
Dumesnil J., Dion D., Yvorchuk K. et al. A new, simple and accurate method for determining ejection fraction by Doppler echocardiography // Can. J. Cardiol.– 1995.– Vol. 11 (11).– P. 1007–1014.
Gelfand E., Haffajee J., Hauser T. et al. Predictors of preserved left ventricular systolic function after surgery for chronic organic mitral regurgitation: a prospective study // J. Heart Valve Dis.– 2010.– Vol. 19 (1).– P. 43–50.
Enriquez-Sarano M., Avierinos J.F., Messika-Zeitoun D. et al. Quantitative determinants of the outcome of asymptomatic mitral regurgitation // New Engl. J. Med.– 2005.– Vol. 352.– P. 8758–8783.
Imasaka K., Tomita Y., Tanoue Y. et al. Early mitral valve surgery for chronic severe mitral regurgitation optimizes left ventricular performance and left ventricular mass regression // J. Thorac. Cardiovasc. Surg.– 2013.– Vol. 146 (1).– P. 61–66.
Magne J., Szymanski C., Fournier A. et al. Clinical and prognostic impact of a new left ventricular ejection index in primary mitral regurgitation because of mitral valve prolapse // Circ. Cardiovasc. Imaging.– 2015.– Vol. 8.– P. e003036.
Ogutu P., Ahmed I., Dunning J. Should patients with asymptomatic severe mitral regurgitation with good left ventricular function undergo surgical repair? // Interact Cardiovasc. Thorac. Surg.– 2010.– Vol. 10 (2).– P. 299–305.
Palmieri V., Manganelli F., Russo C. et al. Accuracy and feasibility of simplified Doppler-based left ventricular ejection fraction // Am. J. Cardiol.– 2013.– Vol. 112 (6).– P. 889–894.
Quintana E., Suri R.M., Thalji N.M. et al. Left ventricular dysfunction after mitral valve repair – the fallacy of «normal» preoperative myocardial function // J. Thorac. Cardiovasc. Surg.– 2014.– Vol. 148.– P. 2752–2762.
Rosenhek R., Rader F., Klaar U. et al. Outcome of watchful waiting in asymptomatic severe mitral regurgitation // Circulation.– 2006.– Vol. 113.– P. 2238–2244.
Teichholz L., Kreulen T., Herman M. et al. Problems in echocardiographic volume determinations: echocardiographic angiographic correlations in the presence or absence of asynergy // Am. J. Cardiol.– 1976.– Vol. 37.– P. 7–11.
Wisenbaugh T., Skudicky D., Sareli P. Prediction of outcome after valve replacement for rheumatic mitral regurgitation in the era of chordal preservation // Circulation.– 1994.– Vol. 89.– P. 191–197.
Zile M. R., Gaasch W.H., Carroll J.D. et al. Chronic mitral regurgitation: Predictive value of preoperative echocardiographic indexes of left ventricular function and wall stress // J. Am. Coll. Cardiol.– 1984.– Vol. 3 (Pt. 1).– P. 235–242.