Prognostic value of forward flow indices in primary mitral regurgitation due to mitral valve prolapse
BackgroundDegenerative mitral regurgitation (DMR) due to mitral valve prolapse (MVP) is a common valve disease associated with significant morbidity and mortality. Timing for surgery is debated for asymptomatic patients without Class I indication, prompting the search for novel parameters of early l...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2023-02-01
|
| Series: | Frontiers in Cardiovascular Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1076708/full |
| _version_ | 1797897112414846976 |
|---|---|
| author | Elisabeth Petolat Elisabeth Petolat Alexis Theron Noemie Resseguier Cyprien Fabre Giulia Norscini Rita Badaoui Gilbert Habib Frederic Collart Stéphane Zaffran Alizée Porto Jean-François Avierinos |
| author_facet | Elisabeth Petolat Elisabeth Petolat Alexis Theron Noemie Resseguier Cyprien Fabre Giulia Norscini Rita Badaoui Gilbert Habib Frederic Collart Stéphane Zaffran Alizée Porto Jean-François Avierinos |
| author_sort | Elisabeth Petolat |
| collection | DOAJ |
| description | BackgroundDegenerative mitral regurgitation (DMR) due to mitral valve prolapse (MVP) is a common valve disease associated with significant morbidity and mortality. Timing for surgery is debated for asymptomatic patients without Class I indication, prompting the search for novel parameters of early left ventricular (LV) systolic dysfunction.AimsTo evaluate the prognostic impact of preoperative forward flow indices on the occurrence of post-operative LV systolic dysfunction.MethodsWe retrospectively included all consecutive patients with severe DMR due to MVP who underwent mitral valve repair between 2014 and 2019. LVOTTVI, forward stroke volume index, and forward LVEF were assessed as potential risk factors for LVEF <50% at 6 months post-operatively.ResultsA total of 198 patients were included: 154 patients (78%) were asymptomatic, and 46 patients (23%) had hypertension. The mean preoperative LVEF was 69 ± 9%. 35 patients (18%) had LVEF ≤ 60%, and 61 patients (31%) had LVESD ≥40 mm. The mean post-operative LVEF was 59 ± 9%, and 21 patients (11%) had post-operative LVEF<50%. Based on multivariable analysis, LVOTTVI was the strongest independent predictor of post-operative LV dysfunction after adjustment for age, sex, symptoms, LVEF, LV end systolic diameter, atrial fibrillation and left atrial volume index (0.75 [0.62–0.91], p < 0.01). The best sensitivity (81%) and specificity (63%) was obtained with LVOTTVI ≤15 cm based on ROC curve analysis.ConclusionLVOTTVI represents an independent marker of myocardial performance impairment in the presence of severe DMR. LVOTTVI could be an earlier marker than traditional echo parameters and aids in the optimization of the timing of surgery. |
| first_indexed | 2024-04-10T07:53:41Z |
| format | Article |
| id | doaj.art-f1da3abd714f4b0781c6ec7bb57a7e24 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-10T07:53:41Z |
| publishDate | 2023-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-f1da3abd714f4b0781c6ec7bb57a7e242023-02-23T08:08:44ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2023-02-011010.3389/fcvm.2023.10767081076708Prognostic value of forward flow indices in primary mitral regurgitation due to mitral valve prolapseElisabeth Petolat0Elisabeth Petolat1Alexis Theron2Noemie Resseguier3Cyprien Fabre4Giulia Norscini5Rita Badaoui6Gilbert Habib7Frederic Collart8Stéphane Zaffran9Alizée Porto10Jean-François Avierinos11Department of Cardiology, La Timone Hospital, Marseille, FranceDepartment of Cardiac Surgery, La Timone Hospital, Marseille, FranceDepartment of Cardiac Surgery, La Timone Hospital, Marseille, FranceEA 3279, Faculté de Médecine, Marseille, FranceEA 3279, Faculté de Médecine, Marseille, FranceDepartment of Cardiology, La Timone Hospital, Marseille, FranceDepartment of Cardiac Surgery, La Timone Hospital, Marseille, FranceDepartment of Cardiology, La Timone Hospital, Marseille, FranceDepartment of Cardiac Surgery, La Timone Hospital, Marseille, FranceU1251 INSERM, Marseille Medical Genetics, Aix-Marseille University, Marseille, FranceDepartment of Cardiac Surgery, La Timone Hospital, Marseille, FranceDepartment of Cardiology, La Timone Hospital, Marseille, FranceBackgroundDegenerative mitral regurgitation (DMR) due to mitral valve prolapse (MVP) is a common valve disease associated with significant morbidity and mortality. Timing for surgery is debated for asymptomatic patients without Class I indication, prompting the search for novel parameters of early left ventricular (LV) systolic dysfunction.AimsTo evaluate the prognostic impact of preoperative forward flow indices on the occurrence of post-operative LV systolic dysfunction.MethodsWe retrospectively included all consecutive patients with severe DMR due to MVP who underwent mitral valve repair between 2014 and 2019. LVOTTVI, forward stroke volume index, and forward LVEF were assessed as potential risk factors for LVEF <50% at 6 months post-operatively.ResultsA total of 198 patients were included: 154 patients (78%) were asymptomatic, and 46 patients (23%) had hypertension. The mean preoperative LVEF was 69 ± 9%. 35 patients (18%) had LVEF ≤ 60%, and 61 patients (31%) had LVESD ≥40 mm. The mean post-operative LVEF was 59 ± 9%, and 21 patients (11%) had post-operative LVEF<50%. Based on multivariable analysis, LVOTTVI was the strongest independent predictor of post-operative LV dysfunction after adjustment for age, sex, symptoms, LVEF, LV end systolic diameter, atrial fibrillation and left atrial volume index (0.75 [0.62–0.91], p < 0.01). The best sensitivity (81%) and specificity (63%) was obtained with LVOTTVI ≤15 cm based on ROC curve analysis.ConclusionLVOTTVI represents an independent marker of myocardial performance impairment in the presence of severe DMR. LVOTTVI could be an earlier marker than traditional echo parameters and aids in the optimization of the timing of surgery.https://www.frontiersin.org/articles/10.3389/fcvm.2023.1076708/fullmitral regurgitationmitral valve prolapseleft ventricular dysfunctionstroke volumemitral repair surgery |
| spellingShingle | Elisabeth Petolat Elisabeth Petolat Alexis Theron Noemie Resseguier Cyprien Fabre Giulia Norscini Rita Badaoui Gilbert Habib Frederic Collart Stéphane Zaffran Alizée Porto Jean-François Avierinos Prognostic value of forward flow indices in primary mitral regurgitation due to mitral valve prolapse Frontiers in Cardiovascular Medicine mitral regurgitation mitral valve prolapse left ventricular dysfunction stroke volume mitral repair surgery |
| title | Prognostic value of forward flow indices in primary mitral regurgitation due to mitral valve prolapse |
| title_full | Prognostic value of forward flow indices in primary mitral regurgitation due to mitral valve prolapse |
| title_fullStr | Prognostic value of forward flow indices in primary mitral regurgitation due to mitral valve prolapse |
| title_full_unstemmed | Prognostic value of forward flow indices in primary mitral regurgitation due to mitral valve prolapse |
| title_short | Prognostic value of forward flow indices in primary mitral regurgitation due to mitral valve prolapse |
| title_sort | prognostic value of forward flow indices in primary mitral regurgitation due to mitral valve prolapse |
| topic | mitral regurgitation mitral valve prolapse left ventricular dysfunction stroke volume mitral repair surgery |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1076708/full |
| work_keys_str_mv | AT elisabethpetolat prognosticvalueofforwardflowindicesinprimarymitralregurgitationduetomitralvalveprolapse AT elisabethpetolat prognosticvalueofforwardflowindicesinprimarymitralregurgitationduetomitralvalveprolapse AT alexistheron prognosticvalueofforwardflowindicesinprimarymitralregurgitationduetomitralvalveprolapse AT noemieresseguier prognosticvalueofforwardflowindicesinprimarymitralregurgitationduetomitralvalveprolapse AT cyprienfabre prognosticvalueofforwardflowindicesinprimarymitralregurgitationduetomitralvalveprolapse AT giulianorscini prognosticvalueofforwardflowindicesinprimarymitralregurgitationduetomitralvalveprolapse AT ritabadaoui prognosticvalueofforwardflowindicesinprimarymitralregurgitationduetomitralvalveprolapse AT gilberthabib prognosticvalueofforwardflowindicesinprimarymitralregurgitationduetomitralvalveprolapse AT fredericcollart prognosticvalueofforwardflowindicesinprimarymitralregurgitationduetomitralvalveprolapse AT stephanezaffran prognosticvalueofforwardflowindicesinprimarymitralregurgitationduetomitralvalveprolapse AT alizeeporto prognosticvalueofforwardflowindicesinprimarymitralregurgitationduetomitralvalveprolapse AT jeanfrancoisavierinos prognosticvalueofforwardflowindicesinprimarymitralregurgitationduetomitralvalveprolapse |