Analysis of factors affecting postoperative left ventricular function recovery in patients with valvular disease combined with heart failure with reduced ejection fraction_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JIN Yan ,  WANG Huishan , ZHANG Jian , YIN Zongtao , ZHU Yan , YU Yan , ZHAO Yang , YUE Fengjie

Department of Cardiac Surgery, General Hospital of Northern Command, Shenyang, 110016, P.R.China;

Corresponding author：

WANG Huishan, Email: huishanw@126.com

Keywords：

Valvular disease; heart failure with reduced ejection fraction; valve surgery; risk factor; treatment

DOI：

10.7507/1007-4848.201912097

Video：

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Objective To analyze factors affecting the recovery of postoperative left ventricular function in patients with valvular disease combined with heart failure with reduced ejection fraction [HFrEF, left ventricular ejection fraction (LVEF)<40%].Methods The clinical data of 98 patients with valvular disease combined with HFrEF who underwent surgeries in our hospital from January 2011 to June 2018 were retrospectively analyzed, including 75 males and 23 females aged 9-78 (55.3±11.9) years.Results A total of 15 patients were dead after the operation, including 4 deaths within 3 months and 11 mid-long-term deaths after the operation. Ninety-one patients were followed up for more than 6 months (10 months to 8.6 years). The postoperative cardiac function (NYHA) of 91 patients was classⅠ-Ⅱ, the LVEF of 18 (19.8%) patients increased more than 10%, that of 47 (51.6%) patients maintained at the preoperative level, and that of 26 (28.6%) patients decreased. Postoperative LVEF was more prone to recover in HFrEF patients with sinus rhythm before operation (P=0.038), valvular disease mainly in aortic valve (P=0.026), obvious reduction of left ventricular end diastolic diameter in early postoperative period (P=0.017), and higher systolic pulmonary artery pressure (SPAP) before operation (P=0.018). The risk factors for postoperative LVEF deterioration included large left atrium before operation (P=0.014), smaller left ventricle end systolic diameter before operation (P=0.003), and fast heart rate after operation (P=0.019). Conclusion Mitral valve prolapse patients with obviously increased left ventricular diameter should receive operation as soon as possible. HFrEF patients with aortic valve disease should receive operation positively. The operation efficacy is satisfactory in the HFrEF patients with high SPAP.

Citation： JIN Yan, WANG Huishan, ZHANG Jian, YIN Zongtao, ZHU Yan, YU Yan, ZHAO Yang, YUE Fengjie. Analysis of factors affecting postoperative left ventricular function recovery in patients with valvular disease combined with heart failure with reduced ejection fraction. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(8): 880-885. doi: 10.7507/1007-4848.201912097 Copy

1.	中华医学会心血管病学分会心力衰竭学组, 中国医师协会心力衰竭专业委员会, 中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南2018. 中华心血管病杂志, 2018, 46(10): 760-789.
2.	Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure of the European Society of Cardiology (ESC) developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J, 2016, 37(27): 2129-2200.
3.	Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol, 2014, 63(22): e57-e185.
4.	Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2017, 38(36): 2739-2791.
5.	Pibarot P, Messika-Zeitoun D, Ben-Yehuda O, et al. Moderate aortic stenosis and heart failure with reduced ejection fraction: can imaging guide us to therapy? JACC Cardiovasc Imaging, 2019, 12(1): 172-184.
6.	Forman R, Firth BG, Barnard MS. Prognostic significance of preoperative left ventricular ejection fraction and valve lesion in patients with aortic valve replacement. Am J Cardiol, 1980, 45(6): 1120-1125.
7.	Henry WL, Bonow RO, Rosing DR, et al. Observations on the optimum time for operative intervention for aortic regurgitation. Ⅱ. Serial echocardiographic evaluation of asymptomatic patients. Circulation, 1980, 61(3): 484-492.
8.	Nishimura RA, Tajik AJ. Quantitative hemodynamics by Doppler echocardiography: a noninvasive alternative to cardiac catheterization. Prog Cardiovasc Dis, 1994, 36(4): 309-342.
9.	Nishimura RA, Carabello B. Operationalizing the 2014 ACC/AHA guidelines for valvular heart disease: a guide for clinicians. J Am Coll Cardiol, 2016, 67(19): 2289-2294.
10.	Wang X, Liu Y, Yuan Y, et al. Short-term prognostic factors in the patients after acute heart failure. Int J Clin Exp Med, 2015, 8(1): 1515-1520.
11.	Loai S, Cheng HM. Heart failure with preserved ejection fraction: the missing pieces in diagnostic imaging. Heart Fail Rev, 2019, 25(2): 305-319.
12.	Freed LA, Levy D, Levine RA, et al. Prevalence and clinical outcome of mitral-valve prolapse. N Engl J Med, 1999, 341(1): 1-7.
13.	Basso C, Perazzolo Marra M, Rizzo S, et al. Arrhythmic mitral valve prolapse and sudden cardiac death. Circulation, 2015, 132(7): 556-566.
14.	Maron BJ, Doerer JJ, Haas TS, et al. Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980-2006. Circulation, 2009, 119(8): 1085-1092.
15.	Levine RA, Jerosch-Herold M, Hajjar RJ. Mitral valve prolapse: A disease of valve and ventricle. J Am Coll Cardiol, 2018, 72(8): 835-837.
16.	Edwards NC, Moody WE, Yuan M, et al. Quantification of left ventricular interstitial fibrosis in asymptomatic chronic primary degenerative mitral regurgitation. Circ Cardiovasc Imaging, 2014, 7(6): 946-953.
17.	Avanesov M, Münch J, Weinrich J, et al. Prediction of the estimated 5-year risk of sudden cardiac death and syncope or non-sustained ventricular tachycardia in patients with hypertrophic cardiomyopathy using late gadolinium enhancement and extracellular volume CMR. Eur Radiol, 2017, 27(12): 5136-5145.
18.	Liu B, Edwards NC, Neal DAH, et al. A prospective study examining the role of myocardial fibrosis in outcome following mitral valve repair in degenerative mitral regurgitation: rationale and design of the mitral FINDER study. BMC Cardiovasc Disord, 2017, 17(1): 282.
19.	金岩, 王辉山, 姜辉, 等. 影响缺血性心肌病血运重建后左心室射血分数的多因素分析. 中国胸心血管外科临床杂志, 2018, 25(12): 1043-1048.
20.	Tornos P, Sambola A, Permanyer-Miralda G, et al. Long-term outcome of surgically treated aortic regurgitation: influence of guideline adherence toward early surgery. J Am Coll Cardiol, 2006, 47(5): 1012-1017.
21.	Yildirim E, Celik M, Yuksel UC, et al. Relationship between pulmonary artery stiffness and functional capacity in patients with heart failure with reduced ejection fraction. Korean Circ J, 2017, 47(6): 929-938.

1. 中华医学会心血管病学分会心力衰竭学组, 中国医师协会心力衰竭专业委员会, 中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南2018. 中华心血管病杂志, 2018, 46(10): 760-789.
2. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure of the European Society of Cardiology (ESC) developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J, 2016, 37(27): 2129-2200.
3. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol, 2014, 63(22): e57-e185.
4. Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2017, 38(36): 2739-2791.
5. Pibarot P, Messika-Zeitoun D, Ben-Yehuda O, et al. Moderate aortic stenosis and heart failure with reduced ejection fraction: can imaging guide us to therapy? JACC Cardiovasc Imaging, 2019, 12(1): 172-184.
6. Forman R, Firth BG, Barnard MS. Prognostic significance of preoperative left ventricular ejection fraction and valve lesion in patients with aortic valve replacement. Am J Cardiol, 1980, 45(6): 1120-1125.
7. Henry WL, Bonow RO, Rosing DR, et al. Observations on the optimum time for operative intervention for aortic regurgitation. Ⅱ. Serial echocardiographic evaluation of asymptomatic patients. Circulation, 1980, 61(3): 484-492.
8. Nishimura RA, Tajik AJ. Quantitative hemodynamics by Doppler echocardiography: a noninvasive alternative to cardiac catheterization. Prog Cardiovasc Dis, 1994, 36(4): 309-342.
9. Nishimura RA, Carabello B. Operationalizing the 2014 ACC/AHA guidelines for valvular heart disease: a guide for clinicians. J Am Coll Cardiol, 2016, 67(19): 2289-2294.
10. Wang X, Liu Y, Yuan Y, et al. Short-term prognostic factors in the patients after acute heart failure. Int J Clin Exp Med, 2015, 8(1): 1515-1520.
11. Loai S, Cheng HM. Heart failure with preserved ejection fraction: the missing pieces in diagnostic imaging. Heart Fail Rev, 2019, 25(2): 305-319.
12. Freed LA, Levy D, Levine RA, et al. Prevalence and clinical outcome of mitral-valve prolapse. N Engl J Med, 1999, 341(1): 1-7.
13. Basso C, Perazzolo Marra M, Rizzo S, et al. Arrhythmic mitral valve prolapse and sudden cardiac death. Circulation, 2015, 132(7): 556-566.
14. Maron BJ, Doerer JJ, Haas TS, et al. Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980-2006. Circulation, 2009, 119(8): 1085-1092.
15. Levine RA, Jerosch-Herold M, Hajjar RJ. Mitral valve prolapse: A disease of valve and ventricle. J Am Coll Cardiol, 2018, 72(8): 835-837.
16. Edwards NC, Moody WE, Yuan M, et al. Quantification of left ventricular interstitial fibrosis in asymptomatic chronic primary degenerative mitral regurgitation. Circ Cardiovasc Imaging, 2014, 7(6): 946-953.
17. Avanesov M, Münch J, Weinrich J, et al. Prediction of the estimated 5-year risk of sudden cardiac death and syncope or non-sustained ventricular tachycardia in patients with hypertrophic cardiomyopathy using late gadolinium enhancement and extracellular volume CMR. Eur Radiol, 2017, 27(12): 5136-5145.
18. Liu B, Edwards NC, Neal DAH, et al. A prospective study examining the role of myocardial fibrosis in outcome following mitral valve repair in degenerative mitral regurgitation: rationale and design of the mitral FINDER study. BMC Cardiovasc Disord, 2017, 17(1): 282.
19. 金岩, 王辉山, 姜辉, 等. 影响缺血性心肌病血运重建后左心室射血分数的多因素分析. 中国胸心血管外科临床杂志, 2018, 25(12): 1043-1048.
20. Tornos P, Sambola A, Permanyer-Miralda G, et al. Long-term outcome of surgically treated aortic regurgitation: influence of guideline adherence toward early surgery. J Am Coll Cardiol, 2006, 47(5): 1012-1017.
21. Yildirim E, Celik M, Yuksel UC, et al. Relationship between pulmonary artery stiffness and functional capacity in patients with heart failure with reduced ejection fraction. Korean Circ J, 2017, 47(6): 929-938.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Analysis of factors affecting postoperative left ventricular function recovery in patients with valvular disease combined with heart failure with reduced ejection fraction

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