Right Ventricular Systolic Function in Organic Mitral Regurgitation

Abstract

Background— To assess the prevalence, determinants, and prognosis value of right ventricular (RV) ejection fraction (EF) impairment in organic mitral regurgitation. Methods and Results— Two hundred eight patients (62±12 years, 138 males) with chronic organic mitral regurgitation referred to surgery underwent an echocardiography and biventricular radionuclide angiography with regional function assessment. Mean RV EF was 40.4±10.2%, ranging from 10% to 65%. RV EF was severely impaired (≤35%) in 63 patients (30%), and biventricular impairment (left ventricular EF<60% and RV EF≤35%) was found in 34 patients (16%). Pathophysiologic correlates of RV EF were left ventricular septal function (β=0.42, P <0.0001), left ventricular end-diastolic diameter index (β=−0.22, P =0.002), and pulmonary artery systolic pressure (β=−0.14, P =0.047). Mitral effective regurgitant orifice size (n=84) influenced RV EF (β=−0.28, P =0.012). In 68 patients examined after surgery, RV EF increased strongly (27.5±4.3–37.9±7.3, P <0.0001) in patients with depressed RV EF, whereas it did not change in others ( P =0.91). RV EF ≤35% impaired 10-year cardiovascular survival (71.6±8.4% versus 89.8±3.7%, P =0.037). Biventricular impairment dramatically reduced 10-year cardiovascular survival (51.9±15.3% versus 90.3±3.2%, P <0.0001; hazard ratio, 5.2; P <0.0001) even after adjustment for known predictors (hazard ratio, 4.6; P =0.004). Biventricular impairment reduced also 10-year overall survival (34.8±13.0% versus 72.6±4.5%, P =0.003; hazard ratio, 2.5; P =0.005) even after adjustment for known predictors ( P =0.048). Conclusions— In patients with organic mitral regurgitation referred to surgery, RV function impairment is frequent (30%) and depends weakly on pulmonary artery systolic pressure but mainly on left ventricular remodeling and septal function. RV function is a predictor of postoperative cardiovascular survival, whereas biventricular impairment is a powerful predictor of both cardiovascular and overall survival.

Right Ventricular Performance After Valve Repair for Chronic Degenerative Mitral Regurgitation

“…As suggested by Le Tourneau et al (4) and as confirmed by our findings, there appears to be a relationship between elevated PASP and RV dysfunction, even though PASP may not be the main determinant of RV performance following mitral valve repair, due to the potential for reversibility.…”

“…This is supported by the findings of Le Tourneau et al (4) who have shown that biventricular impairment is a powerful predictor of both cardiovascular and overall survival. In addition, RV dysfunction has been recognized as a predictor for survival in patients with ischemic or dilated cardiomyopathy after mitral valve annuloplasty (25).…”

“…Le Tourneau et al have shown that RV dysfunction quickly improves following mitral valve surgery (4) and is not associated with poor survival as demonstrated by Sun et al (5). RV impairment is common in chronic degenerative MR and in combination with reduced left ventricular (LV) ejection fraction is a strong predictor of poor cardiovascular and overall survival (4). Thus, a reliable and systematic RV assessment may identify early signs of RV dysfunction, which may assist in the prioritization of surgical referrals in order to avoid biventricular impairment.…”

Echocardiographic Assessment of Right Ventricular Size and Function in Cats With Hypertrophic Cardiomyopathy

“…In humans, right heart assessment has been shown to have a clinically relevant impact on predicting clinical status and outcome in a variety of cardiovascular diseases, including diseases conventionally viewed as left heart‐specific, such as mitral valve disease and HCM 12, 23, 24, 25, 26. Recently, RV function has also been shown to have prognostic value in dogs with arrhythmogenic RV cardiomyopathy and myxomatous mitral valve disease 27, 28.…”

Contractile Properties of the Right Atrial Myofilaments in Patients with Myxomatous Mitral Valve Degeneration

“…The right contractile property is important because right ventricular remodeling may play an important role in clinical outcome of patients undergoing mitral valve surgery [17,18].…”