Nonischemic Mitral Regurgitation: Prognostic Value of Nonsustained Ventricular Tachycardia after Mitral Valve Surgery

作者：Olafiranye Oladipupo; Hochreiter Clare A; Borer Jeffrey S^*; Supino Phyllis G; Herrold Edmund M; Budzikowski Adam S; Hai Ofek Y; Bouraad Dany; Kligfield Paul D; Girardi Leonard N; Krieger Karl H; Isom O Wayne

来源：Cardiology, 2013, 124(2): 108-115.

DOI：10.1159/000347085

• Ejection fraction
• Mitral regurgitation
• Mitral valve surgery
• Ventricular tachycardia

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, %26gt;1 VT episode after MVS predicted SD (p %26lt; 0.01) and CD (SD or heart failure; p %26lt; 0.04). Subnormal postoperative RVEF predicted CD (p %26lt; 0.04). When adjusted for preoperative age, gender, etiology or antiarrhythmics, both postoperative VT and RVEF predicted CD (p %26lt;= 0.05). When postoperative VT and RVEF were both in the multivariable model, only subnormal RVEF predicted CD (p %26lt; 0.04). Among those with normal RVEF, VT %26gt;1 episode predicted SD (p = 0.03). Conclusion: Postoperative VT and subnormal RVEF predict late postoperative deaths in nonischemic MR. Their assessment may aid patient management.

• 出版日期2013