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Frequency, cause and effect on operative outcome of depressed left ventricular ejection fraction in mitral stenosis
R W Snyder1, R A Lange, J E Willard
1Department of Internal Medicine (Cardiovascular Division), University of Texas Southwestern Medical Center, Dallas 75235.
Insights
Approximately one-third of mitral stenosis patients have reduced left ventricular ejection fraction (LVEF). This low LVEF is linked to larger ventricular volumes, suggesting impaired contractility or afterload issues, but does not affect surgical outcomes.
Area of Science:
- Cardiology
- Cardiac Surgery
- Echocardiography
Background:
- Mitral stenosis (MS) can affect left ventricular (LV) function.
- Assessing LV ejection fraction (LVEF) is crucial for understanding MS pathophysiology and surgical outcomes.
Purpose of the Study:
- To determine the incidence of depressed LVEF in isolated MS patients.
- To investigate the pathophysiology of low LVEF in MS.
- To evaluate the impact of depressed LVEF on operative outcomes.
Main Methods:
- Retrospective review of demographic, hemodynamic, and cineangiographic data from 72 isolated MS patients.
- Assessment of operative course and functional class for 45 patients undergoing mitral valve surgery.
- Comparison of patients with LVEF ≤ 0.50 versus LVEF > 0.50.
Main Results:
- 29% (21/72) of patients had a depressed LVEF (≤ 0.50).
- Patients with depressed LVEF had similar hemodynamics but larger LV end-diastolic and end-systolic volumes compared to those with normal LVEF.
- Operative outcomes were similar for patients with depressed LVEF and normal LVEF undergoing valve surgery.
Conclusions:
- A significant proportion of isolated MS patients exhibit depressed LVEF.
- Impaired LV contractile function or increased afterload likely causes low LVEF in MS.
- Depressed LVEF does not adversely impact operative outcomes in mitral stenosis patients undergoing valve surgery.
Abstract:
To assess the incidence, pathophysiology and influence on operative outcome of a depressed left ventricular (LV) ejection fraction (EF) in patients with mitral stenosis (MS), demographic, hemodynamic and cineangiographic data on 72 patients (16 men, 56 women, aged 19 to 75 years) with isolated MS were reviewed. Of the 45 who had mitral commissurotomy or replacement, operative course and functional class before and after surgery were assessed. Of the 72 patients, 21 (29%) had an LVEF < or = 0.50. These 21 were similar to the 51 with an LVEF > 0.50 in age, gender, heart rate, intracardiac pressures, transvalvular gradient and valve area, but they had larger LV end-diastolic (79 +/- 19 [mean +/- SD] vs 59 +/- 15 ml/m2, p < 0.001) and end-systolic volumes (46 +/- 13 vs 23 +/- 8 ml/m2, p < 0.0001). Of the 45 subjects undergoing surgery, operative outcome was similar in the 14 with a depressed and the 31 with a normal LVEF. Thus, about 1/3 of patients with isolated MS have a depressed LVEF. Compared with those with MS and a normal LVEF, these subjects have hemodynamic derangements of similar severity, but they have larger LV end-diastolic and end-systolic volumes, suggesting that impaired LV contractile function or excessive afterload (rather than diastolic underfilling), or both, is the cause of a low LVEF. Those with an LVEF < or = 0.50 who undergo valve surgery have a similar operative outcome as those with an LVEF > 0.50.