title: Right ventricular systolic function in organic mitral regurgitation: impact of biventricular impairment.
abstract: BACKGROUND
  To assess the prevalence, determinants, and prognosis value of right ventricular (RV) ejection fraction (EF) impairment in organic mitral regurgitation.
  
  
  RESULTS
  Two hundred eight patients (62±12 years, 138 males) with chronic organic mitral regurgitation referred to surgery underwent an echocardiography and biventricular radionuclide angiography with regional function assessment. Mean RV EF was 40.4±10.2%, ranging from 10% to 65%. RV EF was severely impaired (≤35%) in 63 patients (30%), and biventricular impairment (left ventricular EF<60% and RV EF≤35%) was found in 34 patients (16%). Pathophysiologic correlates of RV EF were left ventricular septal function (β=0.42, P<0.0001), left ventricular end-diastolic diameter index (β=-0.22, P=0.002), and pulmonary artery systolic pressure (β=-0.14, P=0.047). Mitral effective regurgitant orifice size (n=84) influenced RV EF (β=-0.28, P=0.012). In 68 patients examined after surgery, RV EF increased strongly (27.5±4.3-37.9±7.3, P<0.0001) in patients with depressed RV EF, whereas it did not change in others (P=0.91). RV EF ≤35% impaired 10-year cardiovascular survival (71.6±8.4% versus 89.8±3.7%, P=0.037). Biventricular impairment dramatically reduced 10-year cardiovascular survival (51.9±15.3% versus 90.3±3.2%, P<0.0001; hazard ratio, 5.2; P<0.0001) even after adjustment for known predictors (hazard ratio, 4.6; P=0.004). Biventricular impairment reduced also 10-year overall survival (34.8±13.0% versus 72.6±4.5%, P=0.003; hazard ratio, 2.5; P=0.005) even after adjustment for known predictors (P=0.048).
  
  
  CONCLUSIONS
  In patients with organic mitral regurgitation referred to surgery, RV function impairment is frequent (30%) and depends weakly on pulmonary artery systolic pressure but mainly on left ventricular remodeling and septal function. RV function is a predictor of postoperative cardiovascular survival, whereas biventricular impairment is a powerful predictor of both cardiovascular and overall survival.
authors.affiliation: Inserm, UMR 1087, Institut du thorax, Nantes, France. thletourneau@yahoo.fr
authors.forename: Thierry
authors.initials: T
authors.lastname: Le Tourneau
authors.forename: Guillaume
authors.initials: G
authors.lastname: Deswarte
authors.forename: Nicolas
authors.initials: N
authors.lastname: Lamblin
authors.forename: Claude
authors.initials: C
authors.lastname: Foucher-Hossein
authors.forename: Georges
authors.initials: G
authors.lastname: Fayad
authors.forename: Marjorie
authors.initials: M
authors.lastname: Richardson
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Polge
authors.forename: Claire
authors.initials: C
authors.lastname: Vannesson
authors.forename: Yan
authors.initials: Y
authors.lastname: Topilsky
authors.forename: Francis
authors.initials: F
authors.lastname: Juthier
authors.forename: Jean-Noel
authors.initials: JN
authors.lastname: Trochu
authors.forename: Maurice
authors.initials: M
authors.lastname: Enriquez-Sarano
authors.forename: Christophe
authors.initials: C
authors.lastname: Bauters
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D017052:Hospital Mortality; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D015995:Prevalence; D011379:Prognosis; D015635:Radionuclide Ventriculography; D013318:Stroke Volume; D015996:Survival Rate; D013599:Systole; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology*; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000503:physiopathology*