Mitral regurgitation: relationship of noninvasive descriptors of right and left ventricular performance to clinical and hemodynamic findings and to prognosis in medically and surgically treated patients.

摘要: To determine objective predictors of survival, 53 patients with chronic, hemodynamically severe mitral regurgitation underwent rest and exercise radionuclide cineangiography, echocardiography, treadmill testing, ambulatory electrocardiographic monitoring before prospective (average 30 month) follow-up. At entry, symptom status correlated best radionuclide-based right ventricular ejection fraction (RVEF) left atrial size, while tolerance RVEF during (r = .48, p less than .005). Correspondingly, in 23 who cardiac catheterization, pulmonary arterial systolic wedge pressures were significantly inversely related to RVEF. On the 24 hr electrocardiogram, nonsustained tachycardia was present 29% patients, most frequently when both (LVEF) subnormal (p .03 vs other patients). Since 35 have been managed without surgery for 9 57 months 28); three these subsequently operation also are among 21 undergone valve replacement (MVR). During average 28 observation under medical treatment five nonoperated died; all six RVEFs 30% or at a descriptor that identified those high mortality risk .0001 greater 30%). All eight LVEFs 45% (lower limit normal), predicted mortality. Three died, late after MVR. Among operated only age predictor postoperative survival. A trend toward improved survival found depressed compared did not.