Author + information
- Received November 4, 1999
- Revision received July 5, 2000
- Accepted August 16, 2000
- Published online December 1, 2000.
- Thierry Le Tourneau, MD∗,
- Pascal de Groote, MD†,* (, )
- Alain Millaire, MD, PhD†,
- Claude Foucher, MD‡,
- Christine Savoye, MD∗,
- Pascal Pigny, PhD, PharmD§,
- Alain Prat, MD∥,
- Henri Warembourg, MD∥ and
- Jean Marc Lablanche, MD†
- ↵*Reprint requests and correspondence: Dr. Pascal de Groote, Service de Cardiologie C, Hôpital Cardiologique, CHRU, Boulevard du Pr. J. Leclercq, 59037 Lille Cedex, France
The purpose of this study was to prospectively investigate the effects of surgical correction of mitral regurgitation (MR) on exercise performance, cardiac function and neurohormonal activation.
Little is known about the effect of surgical correction of MR on functional status or on neurohormonal activation.
Cardiopulmonary exercise test, radionuclide angiography and blood samples for assessment of neurohormonal status were obtained in 40 patients with nonischemic MR before and within one year (216 ± 80 days) after surgery. Twenty-four patients underwent mitral valve repair (MVr), and 16 underwent valve replacement (VR) with anterior chordal transection.
Despite an improvement in New York Heart Association functional class, exercise performance did not change (peak oxygen consumption: 19.3 ± 6.1 to 18.5 ± 5.6 ml/kg/min, percentage of maximal predicted oxygen consumption: 79.5 ± 18.2% to 76.8 ± 16.9%). After surgery, left ventricular (LV) ejection fraction (EF) decreased (64.2 ± 10.3% to 59.9 ± 11.4%, p = 0.003) while right ventricular (RV) EF increased (41.4 ± 9.6% to 44.7 ± 9.5%, p = 0.03). Left ventricular EF did not change after MVr (64.3 ± 11.5% to 61.5 ± 12.2%), but RVEF improved (40.4 ± 9.2% to 46.0 ± 10.0%, p = 0.02). In contrast, VR was associated with an impairment of LV function in the apicolateral area and a decrease in LVEF (64.1 ± 8.5% to 57.4 ± 10.0%, p = 0.01), whereas RVEF did not change (42.9 ± 10.3% to 42.8 ± 8.6%). Moreover, there was only a slight decrease in neurohormonal activation after surgery.
Despite an improvement in symptomatic status, exercise performance was not improved seven months after either MVr or VR for MR, and neurohormonal activation persisted. Compared with MVr, VR resulted in a significant impairment of cardiac function in this study.
This study was presented, in part, at the 69th Scientific Sessions of the American Heart Association, New Orleans, Louisiana, November 10 to 13, 1996 and at the 46th Annual Scientific Session of the American College of Cardiology, Anaheim, California, March 16 to 19, 1997.
- Received November 4, 1999.
- Revision received July 5, 2000.
- Accepted August 16, 2000.
- American College of Cardiology