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Association of Heart Rhythm With Exercise Capacity After Operation for Chronic Mitral Regurgitation.
MedLine Citation:
PMID:  22537534     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Although atrial fibrillation (AF) and decreased exercise capacity are common in chronic mitral regurgitation patients, the relationship between rhythm status and exercise capacity after corrective surgery is largely unknown. METHODS: Seventy-one patients undergoing repair or replacement of mitral valve for chronic severe mitral regurgitation were examined with preoperative and 6 months' postoperative cardiopulmonary exercise test and two-dimensional echocardiography. Patients were divided into three groups according to preoperative versus postoperative rhythm (sinus/sinus, SS [n = 42]; AF/sinus, AS [n = 17]; AF/AF, AA group [n = 12]). RESULTS: Preoperative maximal oxygen consumption was lower and ventilatory efficiency was higher in the AS and AA groups compared with the SS group. However, maximal oxygen consumption improved only in the AS group at 6 months' postoperative cardiopulmonary exercise test (24.0 ± 6.9 versus 24.6 ± 6.1 mL · kg(-1)· min(-1) in the SS group, 19.3 ± 5.9 versus 23.2 ± 6.4 mL · kg(-1)· min(-1) in the AS group, 19.8 ± 5.4 versus 18.8 ± 5.1 mL · kg(-1)· min(-1) in the AA group; p = 0.016 for maximal oxygen consumption by analysis of covariance) as well as ventilatory efficiency. Echocardiography verified more significant reduction of left atrial volume in the SS and AS groups than in the AA group (172.2 ± 68.0 versus 96.7 ± 31.0 mL in the SS group, 247.5 ± 77.8 versus 129.2 ± 25.7 mL in the AS group, 316.7 ± 210.0 versus 192.0 ± 95.0 mL in the AA group; p = 0.001 for left atrial volume by analysis of covariance) as well as pulmonary artery systolic pressure. When analyzed for significant predictors of postoperative maximal oxygen consumption, being in the AS group but not the SS group was a significant positive predictor when compared with the AA group (β = 5.475; p = 0.006). CONCLUSIONS: Successful sinus conversion of AF, preferably by maze operation, in patients undergoing surgical correction of chronic severe mitral regurgitation confers improved exercise capacity. Reduction of left atrial volume and pulmonary artery pressure may contribute to this improvement.
Authors:
Seung-Pyo Lee; Yong-Jin Kim; Joo Myung Lee; Ho-Young Hwang; Hyung-Kwan Kim; Kyung-Hwan Kim; Ki-Bong Kim; Dae-Won Sohn; Hyuk Ahn; Byung-Hee Oh; Young-Bae Park
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-4-24
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  -     ISSN:  1552-6259     ISO Abbreviation:  -     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-4-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Affiliation:
Cardiovascular Center, Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
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