Abstract 17048: Prognostic Implication of Enlarged Left Ventricle in Patients Who Underwent Valve Surgery due to Mitral Valve Prolapse or Flail Mitral Valve: Volume versus Dimension

Abstract

Introduction: Left ventricular end-systolic dimension (LVESD) has been being used to guide the optimal timing of surgery in patients with mitral valve prolapse (MVP) or flail mitral valve (FMV). We sought to evaluate whether LVES volume (LVESV) measured by echocardiography can provide additive prognostic information. Methods: Of patients who underwent MV surgery due to MVP or FMV from 2000 to 2014, after exclusion of patients whose rhythm was atrial fibrillation or who needed concomitant maze procedure, aortic valve or coronary bypass surgery, a total of 648 patients (age 51±14 years; ejection fraction 64±7%; LVESD 38±6 mm; LVESV 60±26 mL; repair/replacement = 612/36) was selected. Clinical outcomes included cardiovascular (CV) death, admission due to heart failure (HF) and development of LV dysfunction (EF <45% at the last follow-up). Results: During median follow up of 4.2 years (interquartile range, 1.8-6.6 years), 5 patients died of CV death, 36 admitted for HF, and 38 developed LV dysfunction. Increased LVESD (≥45mm) could not predict CV death. But patients with enlarged LVESV index (LVESV/ body surface area ≥50 ml/m 2 , n=64, 10%) showed higher rate of CV death (p=0.04), HF admission (p=0.04) and composite clinical events (p<0.001). In multivariate regression analysis, enlarged LVESV index was the only independent variable associated with composite clinical events (hazard ratio 2.67, 95% confidence interval 1.39-5.13, p=0.003). Conclusions: In the modern era of MV repair surgery for MVP and FMV, LV volume provides more robust prognostic information than LV dimension.