Right ventricular dysfunction, but not tricuspid regurgitation, is associated with outcome late after left heart valve procedure

Andreas A Kammerlander; Beatrice A Marzluf; Alexandra Graf; Alina Bachmann; Alfred Kocher; Diana Bonderman; Julia Mascherbauer

doi:10.1016/j.jacc.2014.09.062

Right ventricular dysfunction, but not tricuspid regurgitation, is associated with outcome late after left heart valve procedure

J Am Coll Cardiol. 2014 Dec 23;64(24):2633-2642. doi: 10.1016/j.jacc.2014.09.062.

Authors

Andreas A Kammerlander¹, Beatrice A Marzluf², Alexandra Graf³, Alina Bachmann¹, Alfred Kocher⁴, Diana Bonderman¹, Julia Mascherbauer⁵

Affiliations

¹ Department of Cardiology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
² Department of Thoracic Surgery, Otto Wagner Hospital, Vienna, Austria.
³ Department of Medical Statistics, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
⁴ Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
⁵ Department of Cardiology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria. Electronic address: julia.mascherbauer@meduniwien.ac.at.

PMID: 25524343
DOI: 10.1016/j.jacc.2014.09.062

Abstract

Background: Significant tricuspid regurgitation (TR) late after left heart valve procedure is frequent and associated with increased morbidity. Surgical correction carries a significant mortality risk, whereas the impact of TR on survival in these patients is unclear.

Objectives: This study sought to assess the impact of significant TR late after left heart valve procedure.

Methods: A total of 539 consecutive patients with previous left heart valve procedure (time interval from valve procedure to enrollment 50 ± 30 months) were prospectively followed for 53 ± 15 months.

Results: Significant TR (defined as moderate or greater severity by echocardiography) was present in 91 (17%) patients (65% female). Patients with TR presented with more symptoms (New York Heart Association functional class ≥II 55% vs. 31%), lower glomerular filtration rates (61 ± 19 ml/min vs. 68 ± 18 ml/min), and a higher likelihood of atrial fibrillation (41% vs. 20%), all statistically significant. Right ventricular (RV) systolic function was worse in patients with significant TR (RV fractional area change 43 ± 11% vs. 47 ± 9%, p < 0.001). A total of 117 (22%) patients died during follow-up. By Kaplan-Meier analysis, overall survival was significantly worse in patients with significant TR (log-rank p < 0.001). However, by multivariable Cox analysis, only RV fractional area change, age, left atrial size, diabetes, and previous coronary artery bypass graft procedure were significantly associated with mortality, but not tricuspid regurgitation.

Conclusions: RV dysfunction, but not significant TR, is independently associated with survival late after left heart valve procedure.

Keywords: echocardiography; fractional area change; left heart disease; pulmonary hypertension.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aortic Valve / surgery*
Austria
Cardiac Surgical Procedures* / adverse effects
Cardiac Surgical Procedures* / mortality
Comorbidity
Echocardiography
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Mitral Valve / surgery*
Outcome Assessment, Health Care
Postoperative Complications* / diagnosis
Postoperative Complications* / physiopathology
Prognosis
Proportional Hazards Models
Risk Assessment
Risk Factors
Tricuspid Valve Insufficiency* / diagnosis
Tricuspid Valve Insufficiency* / etiology
Tricuspid Valve Insufficiency* / physiopathology
Tricuspid Valve* / diagnostic imaging
Tricuspid Valve* / physiopathology
Ventricular Dysfunction, Right* / diagnosis
Ventricular Dysfunction, Right* / etiology
Ventricular Dysfunction, Right* / physiopathology