Abstract 14285: Predictors of Reverse Remodeling Failure and Survival Following Mitral Valve Repair
Objectives: To elicit predictors of reverse heart remodeling following mitral valve repair.
Methods: We retrospectively identified 494 patients (pts) with preop/postop echocardiographic data. Normal and abnormal categories for left atrial diameter (LA) and left ventricular systolic diameter (LVSD) were based on the American Society of Echocardiography standards. Normal LVSD was defined as ≤4cm. Successful heart remodeling was normalization of all dimensions postoperatively.
Results: The mean age was 56.6±12.7y, 40.5% of pts were female; preop LVDD was 5.8±0.7cm, LVSD 3.6±0.8cm, LA 4.7±0.8cm and LVEF 62±9%. The median study observation time was 77 months; median echocardiographic follow-up time was 38 months. Pts with mild preop LA enlargement were more likely to normalize LA than those with moderate (OR 3.3; 95%CI:1.96-5.6) or severe (OR 5.64; 95%CI:3.3-9.7). Pts with mild preop LVDD enlargement had higher likelihood to normalize LVDD postoperatively than those with severe (OR 5.1; 95%CI:1.9-14). Pts with normal preop LVSD were more likely to normalize the other heart dimensions postoperatively than those with abnormal preop LVSD (OR 2.1; 95%CI:1.2-3.7). Pts with LVEF>50% had increased likelihood for having postoperatively normal LVDD (OR 5.5; 95%CI:2.3-13) and LVSD (OR 6.6; 95%CI:2.9-14.8) but not LA (p=1) compared to pts with LVEF≤50%. Overall, 92.5% of the pts had normal LVDD postoperatively, 90.9% normal LVSD and only 36.8% normal LA. On multivariable logistic regression preop LVSD (OR 1.9; 95%CI:1.1-3.6), preop LA (OR 3.3; 95% CI: 1.1-10.3) and preop severe MR (OR 2.5; 95%CI:1.01-6.4) were predictors of unsuccessful LA reverse remodeling. A Cox regression analysis showed that moderate (HR 1.9; 95%CI:1.2-2.9) or severe preop LA enlargement (HR 2.3; 95% CI:1.5-3.5), preop LVSD (HR 1.3; 95% CI:1.1-1.5) and age over 65y (HR 1.4; 95%CI:1.1-1.78) negatively affect survival and successful remodeling of all 3 heart dimensions.
Conclusions: Preop LVSD and LA significantly affect both the likelihood of successful LA remodeling as well as normalization of all heart dimensions in a survival analysis. These findings support early operation before the increase in heart dimensions is non-reversible.
- © 2011 by American Heart Association, Inc.