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 Enriquez-Sarano, Christophe Bauters

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54 Scopus citations

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

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Le Tourneau, T., Deswarte, G., Lamblin, N., Foucher-Hossein, C., Fayad, G., Richardson, M., Polge, A. S., Vannesson, C., Topilsky, Y., Juthier, F., Trochu, J. N., Enriquez-Sarano, 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