TY - JOUR
T1 - Echocardiographic predictors of survival after surgery for mitral regurgitation in the age of valve repair
AU - Fleischmann, Kirsten E.
AU - Wolff, Simonetta
AU - Lin, Chung Ming
AU - Reimold, Sharon C.
AU - Lee, Thomas H.
AU - Lee, Richard T.
N1 - Funding Information:
From the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School. Dr. Thomas Lee is the recipient of an Established Investigator Award (90019) from the American Heart Association. Dr. Fleischmann is a Merck Fellow of the American College of Cardiolog:~ and was also supported in this work by an institutional grant from the National Heart, Lung, and Blood Institute (T32-HL07604-07). Dr. Reimold is the recipient of a Clinical Investigator Development Award from the National Heart, Lung, and Blood Institute (HL-02758). Received for publication June 5, 1995; accepted July 17, 1995. Reprint requests: Richard T, Lee, MD, Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115 Copyright © 1996 by Mosby--Year Book, Inc. 0002-8703/96/$5.00 + 0 4/1/68579
PY - 1996
Y1 - 1996
N2 - The objective of this study was to identify echocardiographic and clinical predictors of survival after mitral valve surgery when mitral repair is an option. In 132 patients undergoing mitral valve repair or replacement for the diagnosis of mitral regurgitation, preoperative echocardiograms were analyzed quantitatively and reviewed by two independent observers for structural abnormalities of the mitral valve. In Cox regression analysis, clinical factors such as age (mortality rate ratio [MRR] 1.7/decade, 95% confidence intervals [CI] 1.1, 2.4), and New York Heart Association class IV (MRR 3.1,96% CI 1.4, 6.7) and echocardiographic factors including morphologic evidence of endocarditis or myxomatous disease (MRR 0.3, 95% CI 0.1,0.7) were significant predictors of overall survival, although valve repair itself was not. End-systolic dimensions and volumes were not, likely related to the small number of patients with markedly increased end-systolic dimensions or volumes (5 patients [4%] with end-systolic dimension >5.5 cm, 12 patients [9%] with end-systolic volume index >60 ml/m2). New York Heart Association class IV (MRR 2.9, 95% CI 1.3, 6.4), age (MRR 1.7/decade, 95% CI 1.2, 2.6), and the presence of calcification (MRR 4.6, 95% CI 1.3, 16.2) were independent predictors of survival in multivariate analysis. In this contemporary cohort of patients undergoing repair or replacement for mitral regurgitation, factors such as echocardiographically determined cause of disease and presence of calcification predicted survival; traditional measurements such as end-systolic dimensions and volumes were less predictive, most likely because patients underwent surgery before their ventricles became markedly enlarged. Clinical factors such as age and functional status remained the most potent predictors of survival after surgery for mitral regurgitation.
AB - The objective of this study was to identify echocardiographic and clinical predictors of survival after mitral valve surgery when mitral repair is an option. In 132 patients undergoing mitral valve repair or replacement for the diagnosis of mitral regurgitation, preoperative echocardiograms were analyzed quantitatively and reviewed by two independent observers for structural abnormalities of the mitral valve. In Cox regression analysis, clinical factors such as age (mortality rate ratio [MRR] 1.7/decade, 95% confidence intervals [CI] 1.1, 2.4), and New York Heart Association class IV (MRR 3.1,96% CI 1.4, 6.7) and echocardiographic factors including morphologic evidence of endocarditis or myxomatous disease (MRR 0.3, 95% CI 0.1,0.7) were significant predictors of overall survival, although valve repair itself was not. End-systolic dimensions and volumes were not, likely related to the small number of patients with markedly increased end-systolic dimensions or volumes (5 patients [4%] with end-systolic dimension >5.5 cm, 12 patients [9%] with end-systolic volume index >60 ml/m2). New York Heart Association class IV (MRR 2.9, 95% CI 1.3, 6.4), age (MRR 1.7/decade, 95% CI 1.2, 2.6), and the presence of calcification (MRR 4.6, 95% CI 1.3, 16.2) were independent predictors of survival in multivariate analysis. In this contemporary cohort of patients undergoing repair or replacement for mitral regurgitation, factors such as echocardiographically determined cause of disease and presence of calcification predicted survival; traditional measurements such as end-systolic dimensions and volumes were less predictive, most likely because patients underwent surgery before their ventricles became markedly enlarged. Clinical factors such as age and functional status remained the most potent predictors of survival after surgery for mitral regurgitation.
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U2 - 10.1016/S0002-8703(96)90355-5
DO - 10.1016/S0002-8703(96)90355-5
M3 - Article
C2 - 8579022
AN - SCOPUS:0030020267
SN - 0002-8703
VL - 131
SP - 281
EP - 288
JO - American heart journal
JF - American heart journal
IS - 2
ER -