TY - JOUR
T1 - Right ventricular systolic function in organic mitral regurgitation impact of biventricular impairment
AU - Le Tourneau, Thierry
AU - Deswarte, Guillaume
AU - Lamblin, Nicolas
AU - Foucher-Hossein, Claude
AU - Fayad, Georges
AU - Richardson, Marjorie
AU - Polge, Anne Sophie
AU - Vannesson, Claire
AU - Topilsky, Yan
AU - Juthier, Francis
AU - Trochu, Jean Noel
AU - Enriquez-Sarano, Maurice
AU - Bauters, Christophe
PY - 2013/4/16
Y1 - 2013/4/16
N2 - Background.To assess the prevalence, determinants, and prognosis value of right ventricular (RV) ejection fraction (EF) impairment in organic mitral regurgitation. Methods and Results.Two hundred eight patients (62±12 years, 138 males) with chronic organic mitral regurgitation referred to surgery underwent an echocardiography and biventricular radionuclide angiography with regional function assessment. Mean RV EF was 40.4±10.2%, ranging from 10% to 65%. RV EF was severely impaired (≤35%) in 63 patients (30%), and biventricular impairment (left ventricular EF<60% and RV EF≤35%) was found in 34 patients (16%). Pathophysiologic correlates of RV EF were left ventricular septal function (β=0.42, P<0.0001), left ventricular enddiastolic diameter index (β=-0.22, P=0.002), and pulmonary artery systolic pressure (β=.0.14, P=0.047). Mitral effective regurgitant orifice size (n=84) influenced RV EF (β=-0.28, P=0.012). In 68 patients examined after surgery, RV EF increased strongly (27.5±4.3-37.9±7.3, P<0.0001) in patients with depressed RV EF, whereas it did not change in others (P=0.91). RV EF .35% impaired 10-year cardiovascular survival (71.6±8.4% versus 89.8±3.7%, P=0.037). Biventricular impairment dramatically reduced 10-year cardiovascular survival (51.9±15.3% versus 90.3±3.2%, P<0.0001; hazard ratio, 5.2; P<0.0001) even after adjustment for known predictors (hazard ratio, 4.6; P=0.004). Biventricular impairment reduced also 10-year overall survival (34.8±13.0% versus 72.6±4.5%, P=0.003; hazard ratio, 2.5; P=0.005) even after adjustment for known predictors (P=0.048). Conclusions.In patients with organic mitral regurgitation referred to surgery, RV function impairment is frequent (30%) and depends weakly on pulmonary artery systolic pressure but mainly on left ventricular remodeling and septal function. RV function is a predictor of postoperative cardiovascular survival, whereas biventricular impairment is a powerful predictor of both cardiovascular and overall survival.
AB - Background.To assess the prevalence, determinants, and prognosis value of right ventricular (RV) ejection fraction (EF) impairment in organic mitral regurgitation. Methods and Results.Two hundred eight patients (62±12 years, 138 males) with chronic organic mitral regurgitation referred to surgery underwent an echocardiography and biventricular radionuclide angiography with regional function assessment. Mean RV EF was 40.4±10.2%, ranging from 10% to 65%. RV EF was severely impaired (≤35%) in 63 patients (30%), and biventricular impairment (left ventricular EF<60% and RV EF≤35%) was found in 34 patients (16%). Pathophysiologic correlates of RV EF were left ventricular septal function (β=0.42, P<0.0001), left ventricular enddiastolic diameter index (β=-0.22, P=0.002), and pulmonary artery systolic pressure (β=.0.14, P=0.047). Mitral effective regurgitant orifice size (n=84) influenced RV EF (β=-0.28, P=0.012). In 68 patients examined after surgery, RV EF increased strongly (27.5±4.3-37.9±7.3, P<0.0001) in patients with depressed RV EF, whereas it did not change in others (P=0.91). RV EF .35% impaired 10-year cardiovascular survival (71.6±8.4% versus 89.8±3.7%, P=0.037). Biventricular impairment dramatically reduced 10-year cardiovascular survival (51.9±15.3% versus 90.3±3.2%, P<0.0001; hazard ratio, 5.2; P<0.0001) even after adjustment for known predictors (hazard ratio, 4.6; P=0.004). Biventricular impairment reduced also 10-year overall survival (34.8±13.0% versus 72.6±4.5%, P=0.003; hazard ratio, 2.5; P=0.005) even after adjustment for known predictors (P=0.048). Conclusions.In patients with organic mitral regurgitation referred to surgery, RV function impairment is frequent (30%) and depends weakly on pulmonary artery systolic pressure but mainly on left ventricular remodeling and septal function. RV function is a predictor of postoperative cardiovascular survival, whereas biventricular impairment is a powerful predictor of both cardiovascular and overall survival.
KW - Echocardiography
KW - Mitral regurgitation
KW - Radionuclide angiography
KW - Right ventricle
KW - Surgery
UR - http://www.scopus.com/inward/record.url?scp=84876272595&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84876272595&partnerID=8YFLogxK
U2 - 10.1161/CIRCULATIONAHA.112.000999
DO - 10.1161/CIRCULATIONAHA.112.000999
M3 - Article
C2 - 23487435
AN - SCOPUS:84876272595
SN - 0009-7322
VL - 127
SP - 1597
EP - 1608
JO - Circulation
JF - Circulation
IS - 15
ER -