Predicting Left Ventricular Dysfunction after Surgery in Patients with Chronic Mitral Regurgitation: Assessment of Myocardial Deformation by 2-Dimensional Multilayer Speckle Tracking Echocardiography

Abstract

Background and objectives: The development of postoperative left ventricular (LV) dysfunction is a frequent complication in patients with chronic severe mitral valve regurgitation (MR) and portends a poor prognosis. Assessment of myocardial deformation enables myocardial contractility to be accurately estimated. The aim of the present study was to evaluate the predictive value of preoperative regional LV contractile function assessment using two-dimensional multilayer speckle-tracking echocardiography (2D MSTE) analysis in patients with chronic severe MR with preserved LV systolic function.

Subjects and methods: Forty-three consecutive patients with chronic severe MR with preserved LV systolic function scheduled for mitral valve replacement (MVR) or MV repair were prospectively enrolled. Serial echocardiographic studies were performed before surgery, at 7 days follow-up, and at least 3 months follow-up postoperatively. The conventional echocardiographic parameters were analyzed. Global longitudinal strain (GLS) was obtained quantitatively by 2D MSTE.

Results: The mean age of patients was 51.7±14.3 years and 25 (58.1%) were male. In receiver-operating characteristic curve analysis, the most useful cutoff value for discriminating postoperative LV remodeling in severe MR with normal LV systolic function was -20.5% of 2D mid-layer GLS. Patients were divided into two groups by the baseline GLS -20.5%. Preoperative GLS values strongly predicted postoperative LV remodeling or LV dysfunction. The postoperative degree of decrease in LV end-diastolic dimension might be an additive predictive factor.

Conclusion: STE can be used to predict a decrease in LV function after MVR in patients with chronic severe MR. This promising method could be of use in the clinic when trying to decide upon the optimum time to schedule surgery for such patients.

Keywords: Echocardiography; Mitral valve annuloplasty; Mitral valve annulus repair; Mitral valve insufficiency; Mitral valve regurgitation.

Fig. 1. In baseline echocardiography, postoperative echocardiography at 7 days follow-up and postoperative echocardiography at least 3 months follow-up analysis, LVEDD decreased from the baseline echocardiography toward postoperative echocardiography at least 3 months follow-up. And patients with LV remodeling group were larger LVEDD than patients with no-remodeling group. LVEDD: left ventricular end-diastolic dimension, LV: left ventricular.

Fig. 2. It was shown the change of (A) endocardium GLS, (B) mid-layer GLS, (C) epicardium GLS and (D) LVEF in the measuring time. GLS: global longitudinal strain, LVEF: left ventricular ejection fraction.

Fig. 3. Scatter diagram with Pearson's correlation between baseline mid-layer GLS by 2D MSTE and (A) postoperative LVEDD, (B) postoperative LVEF. GLS: global longitudinal strain, 2D MSTE: two-dimensional multilayer speckle-tracking echocardiography, LVEDD: left ventricular end-diastolic dimension, LVEF: left ventricular ejection fraction.

Fig. 4. 2D mid-layer GLS was the most useful cutoff value to severe MR with normal LVEF by receiver-operating characteristic curve analysis. GLS: global longitudinal strain, MV: mitral valve repair, LVEF: left ventricular ejection fraction.