Abstract 16182: Postoperative Outcome in Primary Mitral Regurgitation: Impact of Preoperative Exercise Pulmonary Hypertension
Introduction: The management of asymptomatic patients with primary mitral regurgitation (MR) remains controversial. Exercise-induced pulmonary hypertension (ExPHT) was recently reported as a strong predictor of rapid and frequent occurrence of symptoms, leading to surgery. We aimed to describe the impact of preop. ExPHT on postop. outcome in primary MR.
Method: We prospectively included 109 (NYHA ≤ II) patients (68% male, 65±12 yrs) with primary MR and no LV dysfunction/dilatation, in which we performed exercise echocardiography, in 3 centers (Fr, Bel and Can). The presence of ExPHT was defined as an exercise systolic pulmonary arterial pressure >60mmHg. All patients were closely followed up and operated when indication for surgery was reached. Postop. events were defined as the occurrence of atrial fibrillation (AF), stroke, cardiac-related hospitalization or death.
Results: Among the 109 patients included, 59 have developed ExPHT (58%) and these patients were significantly older than those without ExPHT (66±11 vs. 61±12, p=0.01). There was no difference between the 2 groups regarding gender distribution, baseline LV ejection fraction, left atrial volume or MR severity. Following surgery, 28 predefined end-points were reached (26%): 17 (61%) postop. AF, 4 (14%) strokes, 3 (11%) cardiac-related hospitalization and 4 (14%) deaths. Patients with ExPHT had significant higher rate of postop. event (82% vs. 18%, p=0.0015), even when early postop. AF (i.e. within 48h) was excluded (83% vs. 17%, p=0.004). There was a trend for higher rate of major event (i.e. exclusion of all AF) in the ExPHT group (p=0.07). Event-free survival was significantly lower in ExPHT group, (at 6-year: 50±12% vs. 91±5%, p=0.02). Using Cox multivariate analysis, after adjustment for age, preoperative NYHA functional class and LV ejection fraction, ExPHT was independently associated with higher risk of postop. events (HR=3.2 , 95%CI: 1.2-11.4, p=0.02).
Conclusion: The present study show that ExPHT is associated with reduced postop. event-free survival in asymptomatic patients with primary MR and no LV dysfunction/dilatation. These results emphasize the use of exercise echocardiography and suggest that early surgery could be considered to improve the outcome of these patients.
- © 2013 by American Heart Association, Inc.