Key result
Preoperative LVOT TVI independently predicted post-operative left ventricular dysfunction (LVEF <50%) at 6 months in patients with severe degenerative mitral regurgitation (0.75; 95% CI 0.62-0.91).
Why the study?
Surgical timing is debated for asymptomatic degenerative mitral regurgitation without Class I indications, prompting the search for novel parameters of early left ventricular systolic dysfunction.
Does preoperative LVOT TVI predict post-operative LV systolic dysfunction in patients with severe degenerative mitral regurgitation due to mitral valve prolapse undergoing mitral valve repair?
Cohort (n=198)
Does preoperative LVOT TVI predict post-operative LV systolic dysfunction in patients with severe degenerative mitral regurgitation due to mitral valve prolapse undergoing mitral valve repair?
Effect estimate: Adjusted estimate 0.75 (95% CI 0.62-0.91)
p-value: p=<0.01
Preoperative LVOT TVI is an independent predictor of post-operative LV systolic dysfunction in patients with severe degenerative mitral regurgitation, potentially aiding in optimizing the timing of surgery.
Background Degenerative mitral regurgitation (DMR) due to mitral valve prolapse (MVP) is a common valve disease associated with significant morbidity and mortality. Timing for surgery is debated for asymptomatic patients without Class I indication, prompting the search for novel parameters of early left ventricular (LV) systolic dysfunction. Aims To evaluate the prognostic impact of preoperative forward flow indices on the occurrence of post-operative LV systolic dysfunction. Methods We retrospectively included all consecutive patients with severe DMR due to MVP who underwent mitral valve repair between 2014 and 2019. LVOT TVI , forward stroke volume index, and forward LVEF were assessed as potential risk factors for LVEF <50% at 6 months post-operatively. Results A total of 198 patients were included: 154 patients (78%) were asymptomatic, and 46 patients (23%) had hypertension. The mean preoperative LVEF was 69 ± 9%. 35 patients (18%) had LVEF ≤ 60%, and 61 patients (31%) had LVESD ≥40 mm. The mean post-operative LVEF was 59 ± 9%, and 21 patients (11%) had post-operative LVEF<50%. Based on multivariable analysis, LVOT TVI was the strongest independent predictor of post-operative LV dysfunction after adjustment for age, sex, symptoms, LVEF, LV end systolic diameter, atrial fibrillation and left atrial volume index (0.75 [0.62–0.91], p < 0.01). The best sensitivity (81%) and specificity (63%) was obtained with LVOTTVI ≤15 cm based on ROC curve analysis. Conclusion LVOT TVI represents an independent marker of myocardial performance impairment in the presence of severe DMR. LVOT TVI could be an earlier marker than traditional echo parameters and aids in the optimization of the timing of surgery.
No takes yet. Share an insight, caveat, or question.
Petolat et al. (2023) conducted a cohort in Severe degenerative mitral regurgitation (DMR) due to mitral valve prolapse (MVP) (n=198). Preoperative forward flow indices (LVOT TVI) was evaluated on Left ventricular systolic dysfunction (LVEF <50%) at 6 months post-operatively (Adjusted estimate 0.75, 95% CI 0.62-0.91, p=<0.01). Preoperative LVOT TVI independently predicted post-operative left ventricular dysfunction (LVEF <50%) at 6 months in patients with severe degenerative mitral regurgitation (0.75; 95% CI 0.62-0.91).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: