Circulation, Vol 73, 900-912, Copyright © 1986 by American Heart Association
C Hochreiter, N Niles, RB Devereux, P Kligfield and JS Borer
To determine objective predictors of survival, 53 patients with chronic,
hemodynamically severe mitral regurgitation underwent rest and exercise
radionuclide cineangiography, echocardiography, treadmill exercise testing,
and ambulatory electrocardiographic monitoring before prospective (average
30 month) follow-up. At entry, symptom status correlated best with
radionuclide-based right ventricular ejection fraction (RVEF) and left
atrial size, while treadmill exercise tolerance correlated best with RVEF
during exercise (r = .48, p less than .005). Correspondingly, in 23
patients who underwent cardiac catheterization, pulmonary arterial systolic
and wedge pressures were significantly inversely related to RVEF. On the 24
hr ambulatory electrocardiogram, nonsustained ventricular tachycardia was
present in 29% of patients, most frequently when both RVEF and left
ventricular ejection fraction (LVEF) were subnormal (p = .03 vs other
patients). Since entry, 35 patients have been managed without surgery for 9
to 57 months (average 28); three of these who subsequently underwent
operation also are among the 21 patients who have undergone mitral valve
replacement (MVR). During the average 28 months of observation under
medical treatment five of 35 nonoperated patients have died; all five were
among the six nonoperated patients with RVEFs of 30% or less at entry, a
descriptor that significantly identified those at high mortality risk (p
less than .0001 vs patients with RVEFs greater than 30%). All five also
were among the eight nonoperated patients with LVEFs of 45% or less (lower
limit of normal), a descriptor that also significantly predicted mortality.
Three of the 21 patients who underwent surgery have died, all late after
MVR. Among operated patients, only age was a predictor of postoperative
survival. A trend toward improved survival was found in the patients with
depressed right or left ventricular ejection fraction who underwent surgery
compared with those who did not.
ARTICLES
Mitral regurgitation: relationship of noninvasive descriptors of right and left ventricular performance to clinical and hemodynamic findings and to prognosis in medically and surgically treated patients
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