Right Ventricular Systolic Function in Organic Mitral Regurgitation Impact of Biventricular Impairment

Background-To assess the prevalence, determinants, and prognosis value of right ventricular (RV) ejection fraction (EF) impairment in organic mitral regurgitation. Methods and Results-Two hundred eight patients (62+/-12 years, 138 males) with chronic organic mitral regurgitation referred to surgery underwent an echocardiography and biventricular radionuclide angiography with regional function assessment. Mean RV EF was 40.4+/-10.2%, ranging from 10% to 65%. RV EF was severely impaired (<= 35%) in 63 patients (30%), and biventricular impairment (left ventricular EF<60% and RV EF <= 35%) was found in 34 patients (16%). Pathophysiologic correlates of RV EF were left ventricular septal function (beta=0.42, P<0.0001), left ventricular end-diastolic diameter index (beta=-0.22, P=0.002), and pulmonary artery systolic pressure (beta=-0.14, P=0.047). Mitral effective regurgitant orifice size (n=84) influenced RV EF (beta=-0.28, P=0.012). In 68 patients examined after surgery, RV EF increased strongly (27.5+/-4.3-37.9+/-7.3, P<0.0001) in patients with depressed RV EF, whereas it did not change in others (P=0.91). RV EF <= 35% impaired 10-year cardiovascular survival (71.6+/-8.4% versus 89.8+/-3.7%, P=0.037). Biventricular impairment dramatically reduced 10-year cardiovascular survival (51.9+/-15.3% versus 90.3+/-3.2%, P<0.0001; hazard ratio, 5.2; P<0.0001) even after adjustment for known predictors (hazard ratio, 4.6; P=0.004). Biventricular impairment reduced also 10-year overall survival (34.8+/-13.0% versus 72.6+/-4.5%, P=0.003; hazard ratio, 2.5; P=0.005) even after adjustment for known predictors (P=0.048). Conclusions-In patients with organic mitral regurgitation referred to surgery, RV function impairment is frequent (30%) and depends weakly on pulmonary artery systolic pressure but mainly on left ventricular remodeling and septal function. RV function is a predictor of postoperative cardiovascular survival, whereas biventricular impairment is a powerful predictor of both cardiovascular and overall survival. (Circulation. 2013; 127: 1597-1608.)