PMID- 22698598
OWN - NLM
STAT- MEDLINE
DCOM- 20121113
LR  - 20161125
IS  - 1522-6662 (Electronic)
IS  - 1098-3511 (Linking)
VI  - 15
IP  - 3
DP  - 2012 Jun
TI  - Echocardiographic predictors of adverse short-term outcomes after heart surgery 
      in patients with mitral regurgitation and pulmonary hypertension.
PG  - E127-32
LID - 10.1532/HSF98.20121008 [doi]
AB  - BACKGROUND: Pulmonary hypertension (PH) is a frequent occurrence and a negative 
      prognostic indicator in patients with mitral regurgitation. Preoperative PH 
      causes higher early and late mortality rates after heart surgery, adverse cardiac 
      events, and postoperative systolic dysfunction in the left ventricle (LV). 
      METHODS: The research consisted of a retrospective study of a group of 171 
      consecutive patients with mitral regurgitation and preoperative PH who had 
      undergone mitral valve surgery between January 2008 and October 2011. The PH 
      diagnosis was based on echocardiographic evidence (systolic pulmonary artery 
      pressure [sPAP] >35 mm Hg). The echocardiographic examination included assessment 
      of the following: LV volume, LV ejection fraction (LVEF), sPAP, right ventricular 
      end-diastolic diameter, right atrium area indexed to the body surface area, the 
      ratio of the pulmonary acceleration time to the pulmonary ejection time 
      (PAT/PET), tricuspid annular plane systolic excursion (TAPSE), determination of 
      the severity of the associated tricuspid regurgitation, and presence of 
      pericardial fluid. Surgical procedures consisted of mitral valve repair in 55% of 
      the cases and mitral valve replacement in the remaining 45%. Concomitant coronary 
      artery bypass grafting (CABG) surgery was carried out in 52 patients (30.41%), 
      and De Vega tricuspid annuloplasty was performed in 29 patients (16.95%). The 
      primary end point was perioperative mortality. The secondary end points included 
      the following: pericardial, pleural, hepatic, or renal complications; the need 
      for a new surgical procedure; postoperative mechanical ventilation >24 hours; 
      length of stay in the intensive care unit; duration of postoperative inotropic 
      support; need for an intra-aortic balloon pump; and need for pulmonary 
      vasodilator drugs. RESULTS: The mortality rate was 2.34%. In the univariate 
      analysis, the clinical and echocardiographic parameters associated with mortality 
      were preoperative New York Heart Association (NYHA) class IV, the PAT/PET ratio, 
      TAPSE, the indexed area of the right atrium, and concomitant CABG surgery. In the 
      multivariate analysis, the indexed area of the right atrium and concomitant CABG 
      surgery remained statistically significant. The multivariate analysis also showed 
      the indexed area of the right atrium, LVEF, presence of pericardial fluid, 
      preoperative NYHA class, and concomitant CABG surgery as statistically 
      significant for the secondary end point. The receiver operating characteristic 
      (ROC) curves identified an sPAP value >65 mm Hg to have the highest specificity 
      and sensitivity for the risk of perioperative death in mitral regurgitation 
      patients (area under the ROC curve [AUC], 0.782; P < .001) and identified an sPAP 
      value of 60 mm Hg as the secondary end point (AUC, 0.82; P < .001). Severe PH 
      (sPAP >60 mm Hg) is associated with a significant increase in the mortality rate; 
      a longer stay in the intensive care unit; a mechanical ventilation duration >24 
      hours; lengthy inotropic support; renal, hepatic, and pericardial complications; 
      and a need for endothelin receptor antagonists, phosphodiesterase type 5 
      inhibitors, and/or prostanoids, both in the general group and in patients with 
      preserved systolic functioning of the left ventricle. CONCLUSIONS: PH is a strong 
      short-term negative prognostic factor for patients with mitral regurgitation. The 
      surgical procedure should be performed in the early stages of PH. 
      Echocardiographic examination has useful, simple, and reproducible tools for 
      classifying operative risks. An ischemic etiology and a need for concomitant CABG 
      surgery are additional risk factors for patients with mitral regurgitation and 
      PH.
FAU - Corciova, Flavia Catalina
AU  - Corciova FC
AD  - Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania. 
      flaviaantoniu@yahoo.com
FAU - Corciova, Calin
AU  - Corciova C
FAU - Georgescu, Catalina Arsenescu
AU  - Georgescu CA
FAU - Enache, Mihai
AU  - Enache M
FAU - Anghel, Diana
AU  - Anghel D
FAU - Bartos, Oana
AU  - Bartos O
FAU - Tinica, Grigore
AU  - Tinica G
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Heart Surg Forum
JT  - The heart surgery forum
JID - 100891112
SB  - IM
MH  - Comorbidity
MH  - Echocardiography
MH  - Humans
MH  - Hypertension, Pulmonary/*diagnostic imaging/*mortality/surgery
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve Annuloplasty/*mortality
MH  - Mitral Valve Insufficiency/*diagnostic imaging/mortality/*surgery
MH  - Postoperative Complications/diagnostic imaging/mortality
MH  - Prevalence
MH  - Prognosis
MH  - ROC Curve
MH  - Reproducibility of Results
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Romania/epidemiology
MH  - Sensitivity and Specificity
MH  - Survival Analysis
MH  - Survival Rate
MH  - Treatment Outcome
MH  - Ventricular Dysfunction, Left/*diagnostic imaging/mortality/prevention & control
EDAT- 2012/06/16 06:00
MHDA- 2012/11/14 06:00
CRDT- 2012/06/16 06:00
PHST- 2012/06/16 06:00 [entrez]
PHST- 2012/06/16 06:00 [pubmed]
PHST- 2012/11/14 06:00 [medline]
AID - P5020176806312GH [pii]
AID - 10.1532/HSF98.20121008 [doi]
PST - ppublish
SO  - Heart Surg Forum. 2012 Jun;15(3):E127-32. doi: 10.1532/HSF98.20121008.