European Heart Journal Advance Access originally published online on September 21, 2007
European Heart Journal 2007 28(20):2510-2516; doi:10.1093/eurheartj/ehm375
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Mitral valve repair for dilated cardiomyopathy: predictive role of right ventricular dysfunction
1 Department of Cardiology, ‘San Camillo’ Hospital, via Forlanini 50, University ‘G D'Annunzio’, 66100 Chieti, Italy
2 Department of Cardiac Surgery, University of Catania, Catania, Italy
3 Department of Cardiology, University of L'Aquila, L'Aquila, Italy
4 Department of Cardiac Surgery, University ‘G. D'Annunzio’, Chieti, Italy
Received 25 January 2007; revised 19 July 2007; accepted 10 August 2007; online publish-ahead-of-print 21 September 2007.
* Corresponding author. Tel: +39 0871 41512; fax: +39 0871 402817. E-mail address: mdimauro{at}unich.it
Aims: To evaluate the impact of right ventricular (RV) dysfunction on early and mid-term outcome of patients with ischaemic or dilated cardiomyopathy (DCM) undergoing mitral valve annuloplasty.
Methods and results: From January 1997 to December 2005, 111 patients with DCM (89 ischaemic, 22 non-ischaemic) were enrolled in this retrospective study. Mean age was 67 ± 10 years. Average pre-operative NYHA class was 3.0 ± 0.6. Tricuspid annular plane systolic excursion (TAPSE), tricuspid annular pleak systolic velocity (TAPSV), and RV fractional area change were considered as an index of RV function. A strong relationship between TAPSE and TAPSV were found (r = 0.76). Thirty-day mortality was 10.8%. Five-year survival and possibility to be alive in NYHA classes I–II were 66.5 ± 5.0 and 59.5 ± 5.0%. TAPSE, TAPSV, and MV coaptation depth (MVCD) were found to be risk factors for worse early and mid-term outcome; functional class impaired mid-term outcome. ROC analysis identified TAPSE
12 mm, TAPSV10 cm/s, and MVCD>10 mm as predictive cut-offs.
Conclusion: Pre-operative assessment of some echocardiographic parameters (TAPSE, TAPSV) is very easy, low cost, and provides accurate information on RV function. A good pre-operative clinical compensation has to be necessarily reached before the operation. MVCD should be evaluated to decide surgical strategy (repair or replace).
Key Words: Dilated cardiomyopathy • Mitral valve • Echocardiography • Right ventricle • Right ventricular dysfunction
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