Abstract 3383: Pulmonary Hypertension Predicts Adverse Cardiac Events After Restrictive Mitral Annuloplasty for Functional Mitral Regurgitation and Advanced Cardiomyopathy
Introduction: We investigated whether pulmonary hypertension (PH) noninvasively assessed using continuous wave Doppler of tricuspid regurgitation was an independent predictor in patients undergoing restrictive mitral annuloplasty (RMA) for functional mitral regurgitation (FMR).
Methods: From 1999 to 2008, RMA procedures were performed in 43 patients (62.5±9.3 years) with FMR and advanced cardiomyopathy (EF <40%). Cardiac catheterization was examined at baseline and 1 month after surgery. Clinical follow-up (mean, 35±31 months) and serial echocardiographic examinations were performed to assess survival, New York Heart Association (NYHA) class, MR grade, left atrial dimension, LV dimension, EF, and estimated pulmonary arterial systolic pressure (PASP) at baseline, discharge, and annually thereafter.
Results: NYHA class improved from 3.0±0.2 to 1.8±0.5 (p<0.01) at 3 years after surgery. Improvements in LV systolic function and reverse remodeling were sustained for up to 5 years (Table⇓). Before surgery, the subjects were grouped according to the presence (n=12) or absence (n=31) of PH (estimated PASP >60 mmHg). During the follow-up period, cardiac deaths occurred in 5 patients (4 in PH group, 1 in non-PH group), while 5 (3 in PH group, 2 in non-PH group) were readmitted for cardiac failure and 3 (2 in PH group, 1 in non-PH group) suffered MR recurrence. Freedom from those 3 adverse events at 3 years was 48.0±16.4% in the PH group and 93.8±6.1% in the non-PH group (p<0.001). Multivariate Cox regression analysis identified the preoperative PH as the only significant predictor for the 3 adverse events (hazard ratio, 18.7; CI, 2.1–168). PASP values determined by echocardiography were significantly correlated with those determined by cardiac catheterization (p<0.001, R=0.76).
Conclusion: Noninvasive assessment of PH using continuous-wave Doppler of tricuspid regurgitation can predict adverse cardiac events after RMA for FMR and advanced cardiomyopathy.