One-year LV systolic dysfunction occurred in 20.4% post-MR surgery and independently predicted higher 10-year cardiac death (29% vs 1.7%) and MACCE (41.9% vs 13.2%).
Does 1-year left ventricular systolic dysfunction predict 10-year cardiac death and MACCEs in patients who underwent mitral valve replacement for primary mitral regurgitation?
Persistent left ventricular systolic dysfunction at 1 year after mitral valve replacement for primary mitral regurgitation is a strong independent predictor of 10-year cardiac mortality and MACCEs.
Absolute Event Rate: 0% vs 0%
Abstract Background A significant portion of patients with primary mitral regurgitation (MR) experienced short-term or persistent LV systolic dysfunction (LVSD) postoperatively, provided the initiative volume overload of the LV was corrected by surgery. It was believed to be a negative prognosticator, however, its predictors remained unclear. Purpose This study aimed to identify perioperative predictors of 1-year LVSD and its relationship to 10-year cardiac death and major adverse cardiac/cerebrovascular events (MACCEs) in primary MR patients who received mitral valve replacement. Methods Two hundred and one patients who underwent mitral valve replacement for primary MR at our hospital between 2012 and 2014 were retrospectively enrolled. Those with significant aortic valve diseases, coronary artery disease and mitral stenosis were excluded. Clinical and echocardiography data were collected before surgery, 1 week and 1 year after surgery. Multivariate logistic regression was adopted to identify predictors of 1-year LVSD, and Cox proportional hazards model for risk factors of cardiac death/MACCE. Results A total of 152 patients were included in the final analysis. 31 patients (20.4%) had LVSD at 1-year follow-up (Gp 1) defined as a LV ejection fraction (LVEF) 50%, while the other 121 had a normal LVEF≥50% (Gp 2). At 1 year, Gp1 showed a lower LVEF (36.8 ± 8.5% vs. 61.9 ± 5.3%) and a larger LV end-diastolic dimension (LVEDD) (60.8 ± 8.4mm vs. 47.8 ± 4.4mm) than Gp2 (Both P0.001). There were 11 cardiac mortality and 29 MACCEs in 10-year follow-up, of which 9 cardiac deaths and 13 MACCEs occurred in Gp1 and 2 cardiac deaths (29% vs. 1.7%) and 16 MACCEs (41.9% vs. 13.2%) in Gp 2 (Both P 0.001). The 1-year LVSD served as an independent predictor for both cardiac mortality and MACCEs adjusted for preoperative and 1-week left ventricular parameters. When the 31 patients in Gp1 were further investigated, 13 (41.9%) patients had LVSD at both pre- and 1-week post-surgery, 15 had LVSD at either timepoints (4 at pre-surgery, 11 at 1-week), and only 3 (9.7%) had a normal LVEF at both timepoints. On the other hand, though 20 (13.2%) patients showed LVSD before surgery, of whom 6 (30%) had a quick improvement 1-week after surgery and 4 cases had another drop of LVEF at 1-year. Out of 132 patients with a normal LVEF before surgery, 41 (31.1%) developed LVSD at 1-week, of whom 11 (26.8%) persisted till 1-year. Additionally, 3 patients developed new-onset LVSD by 1 year. The predictors of 1-year LVSD included inpatient time (OR = 1.327, P 0.001), preoperative LVEF (OR = 0.830, P = 0.003), 1-week postoperative LVEF (OR = 0.886, P 0.001) and 1-week postoperative LVEDD (OR = 1.118, P = 0.045). Conclusion One-year persistent LVSD after MR surgery was associated long-term prognosis. Post-surgery 1-week appeared to be an important timepoint to decide whom should be intensively treated with guideline-directed medical therapy.
Zhang et al. (Sat,) reported a other. One-year LV systolic dysfunction occurred in 20.4% post-MR surgery and independently predicted higher 10-year cardiac death (29% vs 1.7%) and MACCE (41.9% vs 13.2%).