Key result
Baseline three-dimensional LV end-systolic volume index was significantly associated with postoperative atrial fibrillation or LV dysfunction (HR 1.06; 95% CI 1.04-1.16).
Why the study?
Does baseline three-dimensional echocardiography predict postoperative atrial fibrillation or left ventricular dysfunction better than standard two-dimensional echocardiography in patients with severe mitral regurgitation undergoing surgery?
Cohort (n=67)
Does baseline three-dimensional echocardiography predict postoperative atrial fibrillation or left ventricular dysfunction better than standard two-dimensional echocardiography in patients with severe mitral regurgitation undergoing surgery?
Hazard Ratio: 1.06 (95% CI 1.04–1.16)
Three-dimensional echocardiography-derived left ventricular end-systolic volume index provides incremental prognostic value over standard 2D echocardiography for predicting postoperative outcomes in patients with severe mitral regurgitation.
May support preoperative risk stratification in severe MR; hypothesis-generating for incremental value over 2D.
BACKGROUND: Increased left ventricular (LV) dimensions are an indication for surgery in patients with asymptomatic mitral regurgitation, but M-mode or two-dimensional measurements have known limitations. The aim of this study was to determine the value of three-dimensional echocardiography in predicting postoperative outcomes after mitral surgery. METHODS: Sixty-seven patients with severe asymptomatic or minimally symptomatic mitral regurgitation (69% men; mean age, 62 ± 13 years) who underwent mitral valve surgery from January 2010 to December 2011 were studied. In addition to standard echocardiography, baseline three-dimensional echocardiography was performed for accurate quantification of LV size. Patients were followed over a median time of 1 month (interquartile range, 0-8 months) for postoperative development of atrial fibrillation or LV dysfunction. A multivariate regression analysis was performed to identify associations with events. RESULTS: Postoperative LV dysfunction developed in 15 patients (22%), and 21 patients (31%) had postoperative atrial fibrillation. There was no association between two-dimensional end-systolic volume index and outcomes (hazard ratio, 1.02; P = .18). Postoperative atrial fibrillation or LV dysfunction was associated with baseline three-dimensional LV end-systolic volume index (hazard ratio, 1.06; 95% confidence interval, 1.04-1.16), independent of age and presence of coronary artery disease. LVESVi ≥ 40 mL/m(2) was the best cutoff value to predict postoperative events (sensitivity, 80%; specificity, 85%). After adding LVESVi to a model containing clinical and echocardiographic parameters, net reclassification improvement was 0.27 (95% confidence interval, 0.25-0.29; P = .024). CONCLUSIONS: LVESVi from three-dimensional echocardiography is an independent predictor of postoperative outcomes in patients with severe mitral regurgitation that is incremental to other clinical and echocardiographic variables.
No takes yet. Share an insight, caveat, or question.
Yingchoncharoen et al. (2014) conducted a cohort in severe asymptomatic or minimally symptomatic mitral regurgitation (n=67). Baseline three-dimensional LV end-systolic volume index (LVESVi) vs. Two-dimensional LV end-systolic volume index was evaluated on Postoperative development of atrial fibrillation or LV dysfunction (HR 1.06, 95% CI 1.04-1.16). Baseline three-dimensional LV end-systolic volume index was significantly associated with postoperative atrial fibrillation or LV dysfunction (HR 1.06; 95% CI 1.04-1.16).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: