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Objectives: This study analyzed the association between pre-operative rest echocardiography and the 6-month post-operative left ventricular ejection fraction (LVEF) in organic mitral regurgitation (MR).Background: LV end-systolic diameter is the marker of LV function in patients with organic MR associated to survival and post-operative EF, but still some patients have nowadays a depressed post-operative LV EF despite correct diameters.Methods: 88 patients (62.6±1.4 yo) were prospectively recruited. They all got a complete echocardiography including the assessment of LV-deformations before the MR repair and all had an echocardiography at 6-month after-surgery. Exclusion criteria were: coronary artery disease, other organic valvular disease, uncontrolled arrhythmia, hemodynamic instability.Results: The principal parameters not correlated to post-operative LVEF (0.5±0.08) are displayed in table I. The univariate analysis concluded that: LV end-systolic diameter (36±0.7mm, R = -0.34, p=0.009); Left atrial area (26.4±1.0cm2; R= -0.37, p=0.011); LV end-diastolic volume (149.9±5.2ml; R=-0.31, p=0.019); LV end-systolic volume (52.3±2.5ml; R=-0.35, p=0.003); Mitral annulus diameter (37±0.7mm; R=-0.25; p=0.01). Using a multivariate linear regression, the GLS/LV end-systolic volume (-4.6±0.3; p=0.01) and the left atrial diameter (44.7±0.8mm; p=0.01) were the best predictor of post-operative LVEF (R2=0.22).Conclusions: In organic MR, LV end-systolic diameter is a key parameter to propose surgery. We demonstrated that global longitudinal strain (GLS, %) normalized for the end-systolic volume is, with the LA size, an important determinant of post-operative EF.