Key result
Pre-operative right ventricular dysfunction (TAPSE ≤12 mm, TAPSV ≤10 cm/s) and mitral valve coaptation depth >10 mm predicted worse early and mid-term outcomes after mitral valve annuloplasty.
Why the study?
Does right ventricular dysfunction predict early and mid-term outcomes in patients with ischaemic or dilated cardiomyopathy undergoing mitral valve annuloplasty?
Cohort (n=111)
Does right ventricular dysfunction predict early and mid-term outcomes in patients with ischaemic or dilated cardiomyopathy undergoing mitral valve annuloplasty?
Pre-operative echocardiographic assessment of right ventricular function (TAPSE, TAPSV) and mitral valve coaptation depth provides predictive value for early and mid-term outcomes in patients with dilated cardiomyopathy undergoing mitral valve annuloplasty.
May support pre-op risk stratification with RV function and coaptation depth in mitral annuloplasty; hypothesis-generating in this observational cohort.
AIMS: To evaluate the impact of right ventricular (RV) dysfunction on early and mid-term outcome of patients with ischaemic or dilated cardiomyopathy (DCM) undergoing mitral valve annuloplasty. METHODS AND RESULTS: From January 1997 to December 2005, 111 patients with DCM (89 ischaemic, 22 non-ischaemic) were enrolled in this retrospective study. Mean age was 67 +/- 10 years. Average pre-operative NYHA class was 3.0 +/- 0.6. Tricuspid annular plane systolic excursion (TAPSE), tricuspid annular pleak systolic velocity (TAPSV), and RV fractional area change were considered as an index of RV function. A strong relationship between TAPSE and TAPSV were found (r = 0.76). Thirty-day mortality was 10.8%. Five-year survival and possibility to be alive in NYHA classes I-II were 66.5 +/- 5.0 and 59.5 +/- 5.0%. TAPSE, TAPSV, and MV coaptation depth (MVCD) were found to be risk factors for worse early and mid-term outcome; functional class impaired mid-term outcome. ROC analysis identified TAPSE < or = 12 mm, TAPSV < or = 10 cm/s, and MVCD>10 mm as predictive cut-offs. CONCLUSION: Pre-operative assessment of some echocardiographic parameters (TAPSE, TAPSV) is very easy, low cost, and provides accurate information on RV function. A good pre-operative clinical compensation has to be necessarily reached before the operation. MVCD should be evaluated to decide surgical strategy (repair or replace).
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Mauro et al. (2007) conducted a cohort in ischaemic or dilated cardiomyopathy (n=111). Mitral valve annuloplasty was evaluated on early and mid-term outcome. Pre-operative right ventricular dysfunction (TAPSE ≤12 mm, TAPSV ≤10 cm/s) and mitral valve coaptation depth >10 mm predicted worse early and mid-term outcomes after mitral valve annuloplasty.