Preoperative Left Ventricular Peak Systolic Pressure/End-Systolic Volume Ratio and Functional Status Following Valve Surgery in Patients With Mitral Regurgitation and Enlarged End-Systolic Volumes

This study was done to determine if the left ventricular (LV) peak systolic pressure/end-systolic volume (PSP/ESV) ratio predicts symptomatic improvement with valve replacement or repair in patients with mitral regurgitation (MR) and an enlarged LV ESV. Patients with MR and LV ESV <30 ml/m2 consistently improve symptomatically with valve surgery, whereas the response of those with an ESV >30 ml/m2 is heterogeneous. The LV PSP/ESV ratio, an easily acquired measure of LV performance, may discriminate those who improve with valve surgery from those who do not. Accordingly, in 40 patients (15 men and 25 women, aged 14 to 74 years) with moderate or severe MR, no other cardiovascular abnormalities, and a LV ESV >30 ml/m2, we assessed the utility of clinical, hemodynamic, and angiographic variables routinely measured preoperatively to predict symptomatic improvement with valve replacement or repair. Of the 40 subjects, 3 died during or within 6 months of surgery. Six months after valve surgery, symptoms had improved in 34 patients, were unchanged in 1, and had worsened in 2. By univariate analysis, only the preoperative pulmonary capillary wedge pressure was predictive of a change in functional class (p = 0.05). The PSP/ESV ratio was not predictive of a change in functional class after valve surgery. Thus, the PSP/ESV ratio does not identify which patients with MR and an enlarged LV ESV will manifest symptomatic improvement with valve surgery. tudy was done to determine if the left ventricular peak systolic pressure/end-systolic volume (PSP/ESV) ratio predicts symptomatic improvement with valve replacement or repair in patients with mitral regurgitation and enlarged left ventricular systolic volume. Of the clinical, hemodynamic, and angiographic variables assessed preoperatively, pulmonary capillary wedge pressure was the strongest predictor of symptomatic improvement 6 months postoperatively; importantly, the preoperative left ventricular PSP/ESV ratio did not discriminate between patients who improved postoperatively and those who did not.