title: Nonischemic mitral regurgitation: prognostic value of nonsustained ventricular tachycardia after mitral valve surgery.
abstract: BACKGROUND
  Nonsustained ventricular tachycardia (VT), frequent in unoperated severe mitral regurgitation (MR), confers mortality risk [sudden death (SD) and cardiac death (CD)]. The prognostic value of VT after mitral valve surgery (MVS) is unknown; we aimed to define this prognostic value and to assess its modulation by left (LV) and/or right (RV) ventricular ejection fraction (EF) for mortality after MVS.
  
  
  METHODS
  In 57 patients (53% females, aged 58 ± 12 years) with severe MR prospectively followed before and after MVS, we performed 24-hour ambulatory electrocardiograms approximately annually. LVEF and RVEF were determined within 1 year after MVS by radionuclide cineangiography.
  
  
  RESULTS
  During 9.52 ± 3.49 endpoint-free follow-up years, late postoperative CD occurred in 11 patients (7 SD, 4 heart failures). In univariable analysis, >1 VT episode after MVS predicted SD (p < 0.01) and CD (SD or heart failure; p < 0.04). Subnormal postoperative RVEF predicted CD (p < 0.04). When adjusted for preoperative age, gender, etiology or antiarrhythmics, both postoperative VT and RVEF predicted CD (p ≤ 0.05). When postoperative VT and RVEF were both in the multivariable model, only subnormal RVEF predicted CD (p < 0.04). Among those with normal RVEF, VT >1 episode predicted SD (p = 0.03).
  
  
  CONCLUSIONS
  Postoperative VT and subnormal RVEF predict late postoperative deaths in nonischemic MR. Their assessment may aid patient management.
authors: Division of Cardiovascular Medicine, Department of Medicine, The Howard Gilman Institute for Heart Valve Disease, State University of New York Downstate Medical Center, Brooklyn, NY, USA.
authors: Oladipupo
authors: O
authors: Olafiranye
authors: Clare A
authors: CA
authors: Hochreiter
authors: Jeffrey S
authors: JS
authors: Borer
authors: Phyllis G
authors: PG
authors: Supino
authors: Edmund M
authors: EM
authors: Herrold
authors: Adam S
authors: AS
authors: Budzikowski
authors: Ofek Y
authors: OY
authors: Hai
authors: Dany
authors: D
authors: Bouraad
authors: Paul D
authors: PD
authors: Kligfield
authors: Leonard N
authors: LN
authors: Girardi
authors: Karl H
authors: KH
authors: Krieger
authors: O Wayne
authors: OW
authors: Isom
mesh_terms: D015716:Electrocardiography, Ambulatory; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D018487:Ventricular Dysfunction, Left / Q000401:mortality / Q000503:physiopathology