Right ventricular systolic function in organic mitral regurgitation impact of biventricular impairment

Thierry Le Tourneau, Guillaume Deswarte, Nicolas Lamblin, Claude Foucher-Hossein, Georges Fayad, Marjorie Richardson, Anne Sophie Polge, Claire Vannesson, Yan Topilsky, Francis Juthier, Jean Noel Trochu, Maurice E Sarano, Christophe Bauters

Research output: Contribution to journalArticle

49 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1597-1608
Number of pages12
JournalCirculation
Volume127
Issue number15
DOIs
StatePublished - Apr 16 2013

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Right Ventricular Function
Mitral Valve Insufficiency
Stroke Volume
Survival
Pulmonary Artery
Radionuclide Angiography
Blood Pressure
Ventricular Remodeling
Left Ventricular Function
Echocardiography

Keywords

  • Echocardiography
  • Mitral regurgitation
  • Radionuclide angiography
  • Right ventricle
  • Surgery

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Le Tourneau, T., Deswarte, G., Lamblin, N., Foucher-Hossein, C., Fayad, G., Richardson, M., ... Bauters, C. (2013). Right ventricular systolic function in organic mitral regurgitation impact of biventricular impairment. Circulation, 127(15), 1597-1608. https://doi.org/10.1161/CIRCULATIONAHA.112.000999

Right ventricular systolic function in organic mitral regurgitation impact of biventricular impairment. / Le Tourneau, Thierry; Deswarte, Guillaume; Lamblin, Nicolas; Foucher-Hossein, Claude; Fayad, Georges; Richardson, Marjorie; Polge, Anne Sophie; Vannesson, Claire; Topilsky, Yan; Juthier, Francis; Trochu, Jean Noel; Sarano, Maurice E; Bauters, Christophe.

In: Circulation, Vol. 127, No. 15, 16.04.2013, p. 1597-1608.

Research output: Contribution to journalArticle

Le Tourneau, T, Deswarte, G, Lamblin, N, Foucher-Hossein, C, Fayad, G, Richardson, M, Polge, AS, Vannesson, C, Topilsky, Y, Juthier, F, Trochu, JN, Sarano, ME & Bauters, C 2013, 'Right ventricular systolic function in organic mitral regurgitation impact of biventricular impairment', Circulation, vol. 127, no. 15, pp. 1597-1608. https://doi.org/10.1161/CIRCULATIONAHA.112.000999
Le Tourneau T, Deswarte G, Lamblin N, Foucher-Hossein C, Fayad G, Richardson M et al. Right ventricular systolic function in organic mitral regurgitation impact of biventricular impairment. Circulation. 2013 Apr 16;127(15):1597-1608. https://doi.org/10.1161/CIRCULATIONAHA.112.000999
Le Tourneau, Thierry ; Deswarte, Guillaume ; Lamblin, Nicolas ; Foucher-Hossein, Claude ; Fayad, Georges ; Richardson, Marjorie ; Polge, Anne Sophie ; Vannesson, Claire ; Topilsky, Yan ; Juthier, Francis ; Trochu, Jean Noel ; Sarano, Maurice E ; Bauters, Christophe. / Right ventricular systolic function in organic mitral regurgitation impact of biventricular impairment. In: Circulation. 2013 ; Vol. 127, No. 15. pp. 1597-1608.
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abstract = "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.",
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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 - Sarano, Maurice E

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

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