О.A. MyshakivskyyPredictors of the deterioration of left ventricular systolic function after surgical intervention in severe primary mitral insufficiency: one-center prospective study

The aim – to verify whether the proposed new echocardiographic parameter of left ventricular (LV) systolic function – so-called effective LV ejection fraction – may become a predictor of occurrence of LV dysfunction in patients with severe primary mitral regurgitation (MR) after mitral valve surgery.

Material and methods. We performed prospective, one-center study and analysed the results of surgical treatment of 72 patients with severe primary MR (mitral valve replacement or repair) in the cardiac surgery department from October 2013 to February 2016. Transthoracic echocardiography was used to evaluate different parameters of LV systolic function, including the new parameter – effective LV ejection fraction. The measurement of parameters was performed three times: before the surgery, during the 1st week and during the 3rd month after surgery. 

Results. Three patients died after the surgery. By applying the diagnostic coefficients (method of Wild – Hubler – Henkin) we determined the threshold point for effective LV ejection fraction, discriminating patients with deterioration of LV systolic function after surgery. We showed that the optimal threshold level was 30 % and the lower level was associated with sensitivity 80 %, specificity 94.4 %, odds ratio 68.0 (95 % confidence interval 10.6–261.7) for prognosis of ejection fraction reduction after surgery.

Conclusion. The parameter of effective LV ejection fraction may be used in patients with severe primary MR in order to predict the risk of LV ejection fraction deterioration after corrective surgery. This parameter might also be helpful for dynamic evaluation of these patients and to determine the terms of corrective mitral valve surgery before occurrence of irreversible LV dysfunction.

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