P374Global longitudinal strain predicts left ventricular dysfunction after mitral valve repair


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Abstract

Background: Previous studies have shown that preoperative left ventricular (LV) ejection fraction, LV end-systolic diameter (LVESD), presence of atrial fibrillation and symptoms were good predictors of LV dysfunction after mitral valve repair (MVr). However, LV global longitudinal systolic strain (GLS) has been recently proposed as novel and sensitive measurement of latent LV dysfunction. The aim of this study was to investigate the value of GLS,measured by 2D speckle tracking analysis, as independent predictor of postoperative LV dysfunction.Methods: A total of 233 patients (61% men, age 61±12 years) with moderate to severe organic MR undergoing MVr were included. Echocardiography was performed at baseline and long-term follow-up (>12 months) after MVr. All patients had successful procedure. The value of GLS as a potential predictor of postoperative LV dysfunction (defined as LV ejection fraction <50% [LVEF]) was studied along with factors already used for optimal timing of the surgery, namely baseline LVEF≤60%, LVESD>40mm, presence of atrial fibrillation and symptoms.Results: At long term follow-up (34±20 months), LVEF decreased from 67±7% before surgery to 61±8% (p<0.001). LV dysfunction was present in 12% of patients. The optimal cut-off value of GLS to predict postoperative LV dysfunction was derived with receiver operating characteristic curve at -19.9% with sensitivity and specificity of 90% and 79% respectively. At univariate logistic regression analyses baseline LVEF, LVESD, atrial fibrillation, presence of symptoms and GLS ≥-19.9% were predictors of postoperative long-term LV dysfunction. At multivariate analysis GLS remained the strongest independent predictor of LV dysfunction with an odds ratio of 24.30 (95%CI 6.93-85.20, p<0.001).Conclusion: Corrective surgery for organic mitral regurgitation results in LVEF preservation at follow-up in majority of patients. LV global longitudinal strain is the major independent predictor of LV dysfunction at follow-up after MVr.

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