Cardiovascular Institute and Shenyang Northern Hospital, Shenyang City, China.
J Card Fail. 2013 Aug;19(8):565-70. doi: 10.1016/j.cardfail.2013.06.001.
A symptomatic reduction in left ventricular ejection fraction (LVEF) is the main reason for postoperative heart failure after valve replacement surgery. However, postoperative heart failure occurs in patients with normal preoperative LVEF. Therefore, we examined clinical and echocardiographic data of patients with rheumatic heart disease to determine additional risk factors for low LVEF in the postoperative period.
Ninety-seven patients with rheumatic heart disease (RHD) who underwent mitral valve replacement for severe mitral valve stenosis were included retrospectively in this study. All patients had normal LVEF before surgery. Patients were divided into 2 groups based on postoperative LVEF 6 months after surgery. Groups A had normal postoperative LVEF (82 cases, 84.5%), and group B had low postoperative LVEF (15 cases, 15.5%). Clinical and electrocardiographic data were collected to determine risk factors for deterioration in cardiac function. Multivariate analysis revealed that preoperative low systolic peak velocities at the lateral tricuspid annulus (St) and no or mild aortic stenosis were independent risk factors for cardiac deterioration in patients with normal preoperative LVEF. Individuals with preoperative St ≤ 4.8 cm/s were more likely to develop lower LVEF at follow-up (χ(2) = 7.54; P = .006; odds ratio 5.03, 95% confidence interval 1.31-20.82). All 15 patients who had normal preoperative LVEF but abnormal postoperative LVEF had no or only mild aortic valve stenosis.
Decreased right ventricular function and no or mild aortic stenosis were independent risk factors for low LVEF at follow-up in patients with RHD who had normal preoperative LVEF. The velocity of the tricuspid valve ring should be included in preoperative evaluations to improve the accuracy of postsurgical prognosis and clinical decision making.
左心室射血分数（LVEF）降低是瓣膜置换术后心力衰竭的主要原因。然而，术前 LVEF 正常的患者也会发生术后心力衰竭。因此，我们检查了风湿性心脏病患者的临床和超声心动图数据，以确定术后 LVEF 降低的其他危险因素。
本研究回顾性纳入 97 例因严重二尖瓣狭窄行二尖瓣置换术的风湿性心脏病患者。所有患者术前 LVEF 正常。根据术后 6 个月的 LVEF 将患者分为 2 组。A 组术后 LVEF 正常（82 例，84.5%），B 组术后 LVEF 降低（15 例，15.5%）。收集临床和心电图数据以确定心功能恶化的危险因素。多因素分析显示，术前三尖瓣环侧壁收缩期峰值速度（St）低和无或轻度主动脉瓣狭窄是术前 LVEF 正常患者心脏功能恶化的独立危险因素。术前 St ≤ 4.8cm/s 的患者更有可能在随访时出现较低的 LVEF（χ(2) = 7.54；P =.006；优势比 5.03，95%置信区间 1.31-20.82）。所有 15 例术前 LVEF 正常但术后 LVEF 异常的患者均无或仅有轻度主动脉瓣狭窄。
对于术前 LVEF 正常的风湿性心脏病患者，右心室功能下降和无或轻度主动脉瓣狭窄是术后 LVEF 降低的独立危险因素。术前评估应包括三尖瓣环速度，以提高术后预后和临床决策的准确性。
