Circulation, Vol 84, 23-34, Copyright © 1991 by American Heart Association
D Reed, RD Abbott, ML Smucker and S Kaul
BACKGROUND. The ability to predict outcome after mitral valve replacement
remains limited in patients with symptomatic chronic mitral regurgitation.
The aims of this study were to determine the preoperative predictors of
postoperative cardiac-related mortality and to assess the additive
prognostic value of tests performed in such patients. METHODS AND RESULTS.
Accordingly, 176 patients (mean age, 57 +/- 14 years) who underwent mitral
valve replacement were followed up for 3.8 +/- 0.5 years. Four categories
of variables were analyzed to predict postoperative cardiac-related
mortality: clinical, laboratory, two-dimensional echocardiographic (2DE),
and cardiac catheterization. There were 39 cardiac-related deaths (29 due
to congestive heart failure and 10 sudden). When the four categories were
analyzed separately, two clinical, one laboratory, two 2DE, and one
catheterization variable best predicted postoperative death. When these six
variables were examined simultaneously, only three (one clinical and two
2DE) remained significant predictors of cardiac-related mortality: presence
of pulmonary rales, left atrial size, and the ratio of left ventricular
wall thickness to left ventricular cavity dimension in end systole. A model
based on these three variables may predict cardiac-related death with
considerable accuracy. Laboratory data did not add to clinical information
for predicting death. 2DE variables provided significant additional
information in this regard (p less than 0.001). Further addition of
catheterization variables was not useful. Prognostic value did not change
significantly when 50 patients with prior mitral valve surgery or 49
patients undergoing concomitant aortic valve replacement or coronary artery
bypass surgery were excluded from analysis. CONCLUSIONS. We conclude that
1) measures of both left ventricular systolic function and left atrial size
are equally important in predicting postoperative cardiac-related mortality
in patients with symptomatic chronic mitral regurgitation undergoing mitral
valve replacement; 2) left atrial size may be important because it reflects
the "history" (severity and duration) of mitral regurgitation; 3) 2DE
assessment of left atrial size and left ventricular function provides
prognostic information that is significantly greater than that obtained
from clinical and laboratory parameters alone; the addition of
catheterization variables does not increase the prognostic value of the
clinical and 2DE data.
ARTICLES
Prediction of outcome after mitral valve replacement in patients with symptomatic chronic mitral regurgitation. The importance of left atrial size
Department of Internal Medicine, University of Virginia School of Medicine, Charlottesville.
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