CLINICAL STUDY
Echocardiographic prediction ofleft ventricular dysfunction aftermitral valve repair for mitral regurgitation as anindicator to decide the optimal timing of repair
Takayoshi Matsumura, MD*,
Eiji Ohtaki, MD*,*,
Kaoru Tanaka, MD*,
Kazuhiko Misu, MD*,
Tetsuya Tobaru, MD*,
Ryuta Asano, MD*,
Masatoshi Nagayama, MD*,
Koichi Kitahara, MD*,
Jun Umemura, MD*,
Tetsuya Sumiyoshi, MD*,
Hitoshi Kasegawa, MD and
Saichi Hosoda, MD*
* Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, JapanFinancial support was given by the Japan Research Promotion Society for Cardiovascular Diseases.
Manuscript received October 28, 2002;
revised manuscript received February 24, 2003,
accepted March 7, 2003.
* Reprint requests and correspondence: Dr. Eiji Ohtaki, Department of Cardiology, Sakakibara Heart Institute, 2-5-4, Yoyogi, Shibuya-ku, Tokyo 151-0053, Japan.
eohtaki{at}shi.heart.or.jp
OBJECTIVES: This study sought to determine whether echocardiography before mitral valve repair (MVR) for mitral regurgitation (MR) was predictive of postoperative left ventricular (LV) dysfunction and useful for deciding the optimal timing of repair.
BACKGROUND: Some reports have shown that the preoperative echocardiographic data of left ventricular ejection fraction (LVEF) and left ventricular end-systolic diameter (LVDs) were good predictors of postoperative LV dysfunction. However, few reports were based on long-term follow-up data of large numbers of patients who underwent MVR in the last decade.
METHODS: A total of 274 patients with moderate or severe MR underwent MVR between October 1, 1991, and September 30, 2000. Among them, 171 patients who had both an operation for isolated MR due to degenerative pathology and a postoperative echocardiogram were studied. Postoperative echocardiograms were performed 3.9 ± 2.4 years after the operation.
RESULTS: The LVEF decreased from 66 ± 10% before surgery to 63 ± 11% after surgery (p < 0.0001). On univariate analysis, preoperative LVEF and LVDs correlated with postoperative LVEF (r = 0.41 and r = –0.39, respectively). Overall, postoperative LV dysfunction (defined as LVEF <50%) was not frequent (12%). However, the incidence of postoperative LV dysfunction was high in patients with preoperative LVEF <55% (38%) or LVDs  40 mm (23%).
CONCLUSIONS: In patients with MR, the echocardiographic data of LVEF and LVDs were good predictors of postoperative LV dysfunction. When a decrease in LVEF or an increase in LVDs is detected, MVR should be considered to preserve postoperative LV function.
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Abbreviations and Acronyms
| | ACC/AHA | | American College of Cardiology/American Heart Association | | ePTFE | | expanded polytetrafluoroethylene | | LV | | left ventricle/ventricular | | LVDd | | left ventricular end-diastolic diameter | | LVDs | | left ventricular end-systolic diameter | | LVEF | | left ventricular ejection fraction | | MR | | mitral regurgitation | | MVR | | mitral valve repair | | NYHA | | New York Heart Association |
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