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Forward Left Ventricular Ejection Fraction as a Predictor of Postoperative Left Ventricular Dysfunction in Patients with Degenerative Mitral Regurgitation

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Abstract
Background: Left ventricular dysfunction (LVD) can occur immediately after mitral valve repair (MVr) for degenerative mitral regurgitation (DMR) in some patients with normal preoperative left ventricular ejection fraction (LVEF). This study investigated whether forward LVEF, calculated as left ventricular outflow tract stroke volume divided by left ventricular end-diastolic volume, could predict LVD immediately after MVr in patients with DMR and normal LVEF. Methods: Echocardiographic and clinical data were retrospectively evaluated in 234 patients with DMR >= moderate and preoperative LVEF >= 60%. LVD and non-LVD were defined as LVEF < 50% and >= 50%, respectively, as measured by echocardiography after MVr and before discharge. Results: Of the 234 patients, 52 (22.2%) developed LVD at median three days (interquartile range: 3-4 days). Preoperative forward LVEF in the LVD and non-LVD groups were 24.0% (18.9-29.5%) and 33.2% (26.4-39.4%), respectively (p < 0.001). Receiver operating characteristic (ROC) analyses showed that forward LVEF was predictive of LVD, with an area under the ROC curve of 0.79 (95% confidence interval: 0.73-0.86), and an optimal cut-off was 31.8% (sensitivity: 88.5%, specificity: 58.2%, positive predictive value: 37.7%, and negative predictive value: 94.6%). Preoperative forward LVEF significantly correlated with preoperative mitral regurgitant volume (correlation coefficient [CC] = -0.86, p < 0.001) and regurgitant fraction (CC = -0.98, p < 0.001), but not with preoperative LVEF (CC = 0.112, p = 0.088). Conclusion: Preoperative forward LVEF could be useful in predicting postoperative LVD immediately after MVr in patients with DMR and normal LVEF, with an optimal cut-off of 31.8%.
Author(s)
김주연남재식김영도진지현최인철
Issued Date
2021
Type
Article
Keyword
Cardiac arrhythmiaCardiovascular diseaseCoronary vesselsdegenerative mitral regurgitationEjection fractionforward left ventricular ejection fractionmitral valve repairpostoperative left ventricular dysfunctionSurgery
DOI
10.3390/jcm10143013
URI
https://oak.ulsan.ac.kr/handle/2021.oak/8079
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_doaj_primary_oai_doaj_org_article_7eff56a632274da5a6a34c12c1216cb3&amp;context=PC&amp;vid=ULSAN&amp;lang=ko_KR&amp;search_scope=default_scope&amp;adaptor=primo_central_multiple_fe&amp;tab=default_tab&amp;query=any,contains,Forward%20Left%20Ventricular%20Ejection%20Fraction%20as%20a%20Predictor%20of%20Postoperative%20Left%20Ventricular%20Dysfunction%20in%20Patients%20with%20Degenerative%20Mitral%20Regurgitation
Publisher
JOURNAL OF CLINICAL MEDICINE
Location
스위스
Language
영어
ISSN
2077-0383
Citation Volume
10
Citation Number
14
Citation Start Page
0
Citation End Page
0
Appears in Collections:
Medicine > Medicine
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