Key result
Pre-operative percentage predicted peak VO2 ≤84% independently predicted impaired post-operative functional capacity at 6 months (HR 1.22; 95% CI 2.13-107.1; P<0.01).
Why the study?
Primary mitral regurgitation is common, but the optimum timing of surgery remains controversial.
Does pre-operative cardiopulmonary exercise testing predict impaired post-operative functional capacity in patients undergoing surgery for severe primary mitral regurgitation?
Observational (n=50)
No
Does pre-operative cardiopulmonary exercise testing predict impaired post-operative functional capacity in patients undergoing surgery for severe primary mitral regurgitation?
Hazard Ratio: 1.22 (95% CI 2.13–107.1)
p-value: p=<0.01
Pre-operative percentage predicted peak VO2 ≤84% is an independent predictor of impaired functional capacity 6 months after surgery for severe primary mitral regurgitation, suggesting a role for CPET in optimizing surgical timing.
Surgery-associated CPET changes in severe primary MR support further evaluation; leaves open whether CPET refines ESC timing beyond current observational data.
Background Primary mitral regurgitation (MR) is one of the most common heart valvular pathologies. However, optimum timing of surgery remains controversial. Purpose To describe changes in cardiopulmonary exercise testing (CPET) parameters after surgery for severe primary MR. Methods In a single centre prospective study, patients undergoing surgery under current ESC guidelines for severe primary MR underwent assessment with transthoracic echocardiogram, CPET, cardiac MRI and quality of life questionnaire pre-operatively and at six months after surgery. The primary outcome was a per protocol analysis of impaired post-operative functional capacity (defined as post-operative left ventricular ejection fraction on transthoracic echocardiogram <50% and/or post-operative percentage predicted peak VO2 ≤84%). Results 43 of the 50 patients recruited between February 2017 and October 2018 were included in the per protocol analysis. Thirty five patients (72.9%) had impaired post-operative functional capacity. In the overall cohort (n=43), there was a significant fall post-operatively in percentage predicted peak VO2 (ppVO2) (81.8±15.7% vs. 76.2±16.2%, p<0.01) and anaerobic threshold (AT) (48.0±11.1% vs. 44.3±10.1%, p=0.01). In patients with a class I indication for surgery (n=30), there was no significant change post-operatively in ppVO2 (79.6±15.7% vs. 75.6±16.7%, p=0.09) or AT (49.9±11.4% vs. 46.4±10.2%, p-0.09). However, in patients with a class II indication for surgery (n=13), there was a significant change post-operatively in ppVO2 (86.9±15.1% vs. 77.4±15.9%, p<0.01), but not in AT (43.5±9.6% vs. 39.5±8.3%, p=0.16). In the multivariable analysis, pre-operative left ventricular ejection fraction ≤60% (hazard ratio, 1.69; 95% confidence interval, 1.56 to 480.1, p=0.04) and pre-operative percentage predicted peak VO2 ≤84% (hazard ratio, 1.22; 95% confidence interval, 2.13 to 107.1, p<0.01) were independent predictors for impaired post-operative functional capacity. Conclusions Pre-operative percentage predicted peak VO2 ≤84% is an independent predictor of impaired post-operative functional capacity. Subject to a confirmatory study, this may help to refine current ESC guidelines for intervention for severe primary MR. Change in ppVO2 after surgery Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Rosetrees Trust and Friends of Hammersmith Hospital
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Afoke et al. (2020) conducted an observational in severe primary mitral regurgitation (n=50). Pre-operative percentage predicted peak VO2 ≤84% was evaluated on impaired post-operative functional capacity (defined as post-operative left ventricular ejection fraction <50% and/or post-operative percentage predicted peak VO2 ≤84%) (HR 1.22, 95% CI 2.13-107.1, p=<0.01). Pre-operative percentage predicted peak VO2 ≤84% independently predicted impaired post-operative functional capacity at 6 months (HR 1.22; 95% CI 2.13-107.1; P<0.01).
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