Preoperative left ventricular ejection fraction and left atrium reverse remodeling after mitral regurgitation surgery.
BACKGROUND
Left atrium enlargement has been associated with cardiac events in patients with mitral regurgitation (MR). Left atrium reverse remodeling (LARR) occur after surgical correction of MR, but the preoperative predictors of this phenomenon are not well known. It is therefore important to identify preoperative predictors for postoperative LARR.


METHODS
We enrolled 62 patients with chronic severe MR (prolapse or flail leaflet) who underwent successful mitral valve surgery (repair or replacement); all with pre- and postoperative echocardiography. LARR was defined as a reduction in left atrium volume index (LAVI) of ≥ 25%. Stepwise multiple regression analysis was used to identify independent predictors of LARR.


RESULTS
LARR occurred in 46 patients (74.2%), with the mean LAVI decreasing from 85.5 mL/m2 to 49.7 mL/m2 (p <0.001). These patients had a smaller preoperative left ventricular systolic volume (p =0.022) and a higher left ventricular ejection fraction (LVEF) (p =0.034). LVEF was identified as the only preoperative variable significantly associated with LARR (odds ratio, 1.086; 95% confidence interval, 1.002-1.178). A LVEF cutoff value of 63.5% identified patients with LARR of ≥ 25% with a sensitivity of 71.7% and a specificity of 56.3%.


CONCLUSIONS
LARR occurs frequently after mitral valve surgery and is associated with preoperative LVEF higher than 63.5%.
Lucia R
LR
Machado
Zilda M
ZM
Meneghelo
David C S
DC
Le Bihan
Rodrigo B M
RB
Barretto
Antonio C
AC
Carvalho
Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil. vmoises@unifesp.br.
Valdir A
VA
Moises
D064752:Atrial Remodeling; D004452:Echocardiography / Q000379:methods; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D011300:Preoperative Care; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000517:prevention & control*