Circulation, Vol 64, 1212-1217, Copyright © 1981 by American Heart Association
BA Carabello, SP Nolan and LB McGuire
Twenty-one patients with symptomatic, chronic, severe mitral regurgitation
(MR) but without other valvular heart disease or coronary disease were
evaluated to determine which hemodynamic and angiographic factors might be
prognostic of surgical outcome. Sixteen patients were in New York Heart
Association functional classes I or II postoperatively and formed group A.
One patient remained in class III postoperatively and four patients died
perioperatively; they constitute group B. End-diastolic volume index (EDVI)
was less for group A than for group B, 119 +/- 25 ml/m2 vs 170 +/- 28 ml/m2
(p less than 0.001). End-systolic volume index (ESVI) was also lower in
group A, 39 +/- 19 ml/m2 vs 72 +/- 32 ml/m2 for group B (p less than 0.01).
The ratio of end-systolic wall stress to end-systolic volume index
(ESWS/ESVI) was examined in normal persons and in groups A and B. This
ratio was significantly lower in both groups than in normal persons,
indicating relatively greater end-systolic volume at a given wall stress,
suggesting left ventricular dysfunction. The ESWS/ESVI ratio in group B,
2.2 +/- 0.2, was significantly less than in group A, 3.3 +/- 0.4 (p less
than 0.001). The variables of age, pulmonary capillary wedge pressure,
EDVI, ESVI, ejection fraction and the ESWS/ESVI ratio were subjected to
stepwise discriminant multivariate analysis to determine if any were
independent predictors of outcome. The only independent predictor
determined by this method was the ESWS/ESVI ratio (p less than 0.001). We
conclude that the ESWS/ESVI ratio may be helpful in evaluating left
ventricular function and operative risk in patients with chronic,
symptomatic MR.
ARTICLES
Assessment of preoperative left ventricular function in patients with mitral regurgitation: value of the end-systolic wall stress-end- systolic volume ratio
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