What is the clinical evidence from this study?

Study design: Cohort. Population: ischaemic or dilated cardiomyopathy (n=111). Intervention: Mitral valve annuloplasty. Primary outcome: early and mid-term outcome.

September 7, 2007Open Access

Mitral valve repair for dilated cardiomyopathy: predictive role of right ventricular dysfunction

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.

Study Design

Type

Cohort (n=111)

Structured PICO

Does right ventricular dysfunction predict early and mid-term outcomes in patients with ischaemic or dilated cardiomyopathy undergoing mitral valve annuloplasty?

Population

111 patients with ischaemic (n=89) or non-ischaemic (n=22) dilated cardiomyopathy (DCM) undergoing mitral valve annuloplasty, mean age 67 +/- 10 years, average pre-operative NYHA class 3.0 +/- 0.6.

Intervention

Mitral valve annuloplasty with pre-operative echocardiographic assessment of right ventricular function (TAPSE, TAPSV) and mitral valve coaptation depth (MVCD).

Outcome

Early and mid-term outcome (30-day mortality, 5-year survival, and possibility to be alive in NYHA classes I-II).hard clinical

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.

Abstract

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 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).