Increased aorto-mitral curtain thickness independently predicts mortality in patients with radiation-associated cardiac disease undergoing cardiac surgery

Milind Y. Desai, Willis Wu, Ahmad Masri, Zoran B. Popovic, Shikhar Agarwal, Nicholas G. Smedira, Bruce W. Lytle, Brian P. Griffin

Research output: Contribution to journalArticle

Abstract

Background Thoracic radiation leads to radiation-associated cardiac disease (RACD), associated with substantial cardiac morbidity and mortality, often requiring complex cardiothoracic surgery. In patients with RACD, along with valvular lesions, the aorto-mitral curtain (AMC, junction between base of anterior mitral leaflet and aortic root) thickness is increased on transthoracic echocardiography. We sought to identify clinical and transthoracic echocardiography predictors of long-term mortality in patients with RACD. Methods We studied 173 patients with RACD (75% women, 63 ± 14 years, 53% with breast cancer, 27% with Hodgkin lymphoma; mean time from radiation, 18 ± 12 years), who underwent cardiothoracic surgery (26% redo) between 2000 and 2003. Clinical, transthoracic echocardiography (along with AMC), and surgical variables were recorded. Preoperative EuroSCORE and all-cause mortality were recorded. Results Mean left ventricular ejection fraction, right systolic ventricular pressure, and AMC thickness were 0.49 ± 0.13, 41 ± 15 mm Hg, and 0.54 ± 0.2 cm, respectively. Fifty-one percent of patients had II+ mitral regurgitation or greater, 29% patients had II+ aortic regurgitation or greater, 23% patients had severe aortic stenosis, and 34% patients had II+ tricuspid regurgitation or greater. In 7.6 ± 3 years of follow-up, there were 95 (55%) deaths, with a 30-day mortality rate of only 7 (4%). Absence of β-blockers (hazard ratio, 0.49; 95% confidence interval, 0.31 to 0.79), aspirin (hazard ratio, 0.53; 95% confidence interval, 0.33 to 0.84), higher EuroSCORE (hazard ratio, 1.11; 95% confidence interval, 1.02 to 1.21), and greater AMC thickness (hazard ratio, 5.75; 95% confidence interval, 1.57 to 21.03; all p <0.01) independently predicted mortality. Aorto-mitral curtain thickness of at least 0.6 cm was associated with significantly increased mortality. Conclusions Patients with RACD undergoing cardiothoracic surgery have high long-term mortality, which is independently predicted by AMC thickness, a higher preoperative risk score, and lack of cardioprotective medications.

Original languageEnglish (US)
Pages (from-to)1348-1355
Number of pages8
JournalAnnals of Thoracic Surgery
Volume97
Issue number4
DOIs
StatePublished - 2014
Externally publishedYes

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Thoracic Surgery
Heart Diseases
Radiation
Mortality
Confidence Intervals
Echocardiography
Background Radiation
Tricuspid Valve Insufficiency
Aortic Valve Insufficiency
Aortic Valve Stenosis
Mitral Valve Insufficiency
Ventricular Pressure
Hodgkin Disease
Stroke Volume
Aspirin
Thorax
Breast Neoplasms
Blood Pressure
Morbidity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

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Increased aorto-mitral curtain thickness independently predicts mortality in patients with radiation-associated cardiac disease undergoing cardiac surgery. / Desai, Milind Y.; Wu, Willis; Masri, Ahmad; Popovic, Zoran B.; Agarwal, Shikhar; Smedira, Nicholas G.; Lytle, Bruce W.; Griffin, Brian P.

In: Annals of Thoracic Surgery, Vol. 97, No. 4, 2014, p. 1348-1355.

Research output: Contribution to journalArticle

Desai, Milind Y. ; Wu, Willis ; Masri, Ahmad ; Popovic, Zoran B. ; Agarwal, Shikhar ; Smedira, Nicholas G. ; Lytle, Bruce W. ; Griffin, Brian P. / Increased aorto-mitral curtain thickness independently predicts mortality in patients with radiation-associated cardiac disease undergoing cardiac surgery. In: Annals of Thoracic Surgery. 2014 ; Vol. 97, No. 4. pp. 1348-1355.
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title = "Increased aorto-mitral curtain thickness independently predicts mortality in patients with radiation-associated cardiac disease undergoing cardiac surgery",
abstract = "Background Thoracic radiation leads to radiation-associated cardiac disease (RACD), associated with substantial cardiac morbidity and mortality, often requiring complex cardiothoracic surgery. In patients with RACD, along with valvular lesions, the aorto-mitral curtain (AMC, junction between base of anterior mitral leaflet and aortic root) thickness is increased on transthoracic echocardiography. We sought to identify clinical and transthoracic echocardiography predictors of long-term mortality in patients with RACD. Methods We studied 173 patients with RACD (75{\%} women, 63 ± 14 years, 53{\%} with breast cancer, 27{\%} with Hodgkin lymphoma; mean time from radiation, 18 ± 12 years), who underwent cardiothoracic surgery (26{\%} redo) between 2000 and 2003. Clinical, transthoracic echocardiography (along with AMC), and surgical variables were recorded. Preoperative EuroSCORE and all-cause mortality were recorded. Results Mean left ventricular ejection fraction, right systolic ventricular pressure, and AMC thickness were 0.49 ± 0.13, 41 ± 15 mm Hg, and 0.54 ± 0.2 cm, respectively. Fifty-one percent of patients had II+ mitral regurgitation or greater, 29{\%} patients had II+ aortic regurgitation or greater, 23{\%} patients had severe aortic stenosis, and 34{\%} patients had II+ tricuspid regurgitation or greater. In 7.6 ± 3 years of follow-up, there were 95 (55{\%}) deaths, with a 30-day mortality rate of only 7 (4{\%}). Absence of β-blockers (hazard ratio, 0.49; 95{\%} confidence interval, 0.31 to 0.79), aspirin (hazard ratio, 0.53; 95{\%} confidence interval, 0.33 to 0.84), higher EuroSCORE (hazard ratio, 1.11; 95{\%} confidence interval, 1.02 to 1.21), and greater AMC thickness (hazard ratio, 5.75; 95{\%} confidence interval, 1.57 to 21.03; all p <0.01) independently predicted mortality. Aorto-mitral curtain thickness of at least 0.6 cm was associated with significantly increased mortality. Conclusions Patients with RACD undergoing cardiothoracic surgery have high long-term mortality, which is independently predicted by AMC thickness, a higher preoperative risk score, and lack of cardioprotective medications.",
author = "Desai, {Milind Y.} and Willis Wu and Ahmad Masri and Popovic, {Zoran B.} and Shikhar Agarwal and Smedira, {Nicholas G.} and Lytle, {Bruce W.} and Griffin, {Brian P.}",
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TY - JOUR

T1 - Increased aorto-mitral curtain thickness independently predicts mortality in patients with radiation-associated cardiac disease undergoing cardiac surgery

AU - Desai, Milind Y.

AU - Wu, Willis

AU - Masri, Ahmad

AU - Popovic, Zoran B.

AU - Agarwal, Shikhar

AU - Smedira, Nicholas G.

AU - Lytle, Bruce W.

AU - Griffin, Brian P.

PY - 2014

Y1 - 2014

N2 - Background Thoracic radiation leads to radiation-associated cardiac disease (RACD), associated with substantial cardiac morbidity and mortality, often requiring complex cardiothoracic surgery. In patients with RACD, along with valvular lesions, the aorto-mitral curtain (AMC, junction between base of anterior mitral leaflet and aortic root) thickness is increased on transthoracic echocardiography. We sought to identify clinical and transthoracic echocardiography predictors of long-term mortality in patients with RACD. Methods We studied 173 patients with RACD (75% women, 63 ± 14 years, 53% with breast cancer, 27% with Hodgkin lymphoma; mean time from radiation, 18 ± 12 years), who underwent cardiothoracic surgery (26% redo) between 2000 and 2003. Clinical, transthoracic echocardiography (along with AMC), and surgical variables were recorded. Preoperative EuroSCORE and all-cause mortality were recorded. Results Mean left ventricular ejection fraction, right systolic ventricular pressure, and AMC thickness were 0.49 ± 0.13, 41 ± 15 mm Hg, and 0.54 ± 0.2 cm, respectively. Fifty-one percent of patients had II+ mitral regurgitation or greater, 29% patients had II+ aortic regurgitation or greater, 23% patients had severe aortic stenosis, and 34% patients had II+ tricuspid regurgitation or greater. In 7.6 ± 3 years of follow-up, there were 95 (55%) deaths, with a 30-day mortality rate of only 7 (4%). Absence of β-blockers (hazard ratio, 0.49; 95% confidence interval, 0.31 to 0.79), aspirin (hazard ratio, 0.53; 95% confidence interval, 0.33 to 0.84), higher EuroSCORE (hazard ratio, 1.11; 95% confidence interval, 1.02 to 1.21), and greater AMC thickness (hazard ratio, 5.75; 95% confidence interval, 1.57 to 21.03; all p <0.01) independently predicted mortality. Aorto-mitral curtain thickness of at least 0.6 cm was associated with significantly increased mortality. Conclusions Patients with RACD undergoing cardiothoracic surgery have high long-term mortality, which is independently predicted by AMC thickness, a higher preoperative risk score, and lack of cardioprotective medications.

AB - Background Thoracic radiation leads to radiation-associated cardiac disease (RACD), associated with substantial cardiac morbidity and mortality, often requiring complex cardiothoracic surgery. In patients with RACD, along with valvular lesions, the aorto-mitral curtain (AMC, junction between base of anterior mitral leaflet and aortic root) thickness is increased on transthoracic echocardiography. We sought to identify clinical and transthoracic echocardiography predictors of long-term mortality in patients with RACD. Methods We studied 173 patients with RACD (75% women, 63 ± 14 years, 53% with breast cancer, 27% with Hodgkin lymphoma; mean time from radiation, 18 ± 12 years), who underwent cardiothoracic surgery (26% redo) between 2000 and 2003. Clinical, transthoracic echocardiography (along with AMC), and surgical variables were recorded. Preoperative EuroSCORE and all-cause mortality were recorded. Results Mean left ventricular ejection fraction, right systolic ventricular pressure, and AMC thickness were 0.49 ± 0.13, 41 ± 15 mm Hg, and 0.54 ± 0.2 cm, respectively. Fifty-one percent of patients had II+ mitral regurgitation or greater, 29% patients had II+ aortic regurgitation or greater, 23% patients had severe aortic stenosis, and 34% patients had II+ tricuspid regurgitation or greater. In 7.6 ± 3 years of follow-up, there were 95 (55%) deaths, with a 30-day mortality rate of only 7 (4%). Absence of β-blockers (hazard ratio, 0.49; 95% confidence interval, 0.31 to 0.79), aspirin (hazard ratio, 0.53; 95% confidence interval, 0.33 to 0.84), higher EuroSCORE (hazard ratio, 1.11; 95% confidence interval, 1.02 to 1.21), and greater AMC thickness (hazard ratio, 5.75; 95% confidence interval, 1.57 to 21.03; all p <0.01) independently predicted mortality. Aorto-mitral curtain thickness of at least 0.6 cm was associated with significantly increased mortality. Conclusions Patients with RACD undergoing cardiothoracic surgery have high long-term mortality, which is independently predicted by AMC thickness, a higher preoperative risk score, and lack of cardioprotective medications.

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