Circulation, Vol 74, 1309-1316, Copyright © 1986 by American Heart Association
BA Carabello, H Williams, AK Gash, R Kent, D Belber, A Maurer, J Siegel, K Blasius and JF Spann
The afterload-corrected end-systolic volume index (ratio of end- systolic
stress to end-systolic volume index [ESS/ESVI]) was previously useful in
predicting outcome in patients with mitral regurgitation undergoing valve
replacement. Therefore we tested ESS/ESVI together with standard
hemodynamic variables as possible predictors of outcome in 39 patients with
various valvular lesions who underwent valve replacement. Thirteen patients
had preoperative mitral regurgitation, 16 had aortic stenosis, nine had
aortic regurgitation, and one had mitral stenosis. Twenty-seven patients
(group S) had a satisfactory outcome as defined by a return to NYHA class I
or II together with a normal postoperative ejection fraction. Twelve
patients who died, remained in class III or IV, or had a subnormal
postoperative ejection fraction were deemed to have an unsatisfactory
result (group U). Mean right atrial pressure, pulmonary arterial pressure,
pulmonary capillary wedge pressure, end-diastolic volume index,
end-systolic volume index (ESVI), and end-systolic wall stress were all
greater in group U, whereas ESS/ESVI and ejection fraction were lower in
group U. When these and other factors were submitted to stepwise
discriminant multivariate analysis, ESS/ESVI and ESVI were the only
independent predictors of outcome. However, when patients with mitral
regurgitation (who might have biased the study) were excluded, discriminant
analysis showed ESVI as the only independent predictive variable. We
conclude that end-systolic indicators of ventricular function are superior
to other standard hemodynamic variables in predicting outcome of valve
replacement.
ARTICLES
Hemodynamic predictors of outcome in patients undergoing valve replacement [published erratum appears in Circulation 1987 Mar;75(3):650]
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