FREQUENCY, CAUSE AND EFFECT ON OPERATIVE OUTCOME OF DEPRESSED LEFT-VENTRICULAR EJECTION FRACTION IN MITRAL-STENOSIS

To assess the incidence, pathophysiology and ib fluence on operative o utcome of a depressed left ventricular (LV) ejection fraction (EF) in patients with mitral stenosis (MS), demographic, hemodynamic and cinea ngiographic data on 72 patients (16 men, 56 women, aged 19 to 75 years ) with isolated MS were reviewed. of the 45 who had mitral commissurot omy or replacement, operative course and functional class before and a fter surgery were assessed. OF the 72 patients, 21 (29%) had an LVEF l ess than or equal to 0.50. These 21 were similar to the 51 with an LVE F >0.50 in age, gender, heart rate, intracardiac pressures, transvalvu lar gradient and valve area, but they had larger LV end-diastolic (79 +/- 19 [mean +/- SD] vs 59 +/- 15 ml/m(2), p <0.001) and end-systolic volumes (46 +/- 13 vs 23 +/- 8 ml/m(2), p <0.0001). Of the 45 subjects undergoing surgery, operative outcome was similar in the 14 with a de pressed and the 31 with a normal LVEF. Thus, about 1/3 of patients wit h isolated MS have a depressed LVEF. compared with those with MS and a normal LVEF, these subjects have hemodynamic derangements of similar severity, but they have larger LV end diastolic and end-systolic volum es, suggesting that impaired LV contractile function or excessive afte rload (rather than diastolic underfilling, or both, is the cause of a low LVEF. Those with an LVEF less than or equal to 0.50 who undergo va lve surgery have a similar operative outcome as those with an LVEF >0. 50.