Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Aug;9(4):2686-2694.
doi: 10.1002/ehf2.14001. Epub 2022 Jun 6.

Global longitudinal strain and outcome after endoscopic mitral valve repair

Martin Kotrc  1   2 , Jozef Bartunek  1 , Jan Benes  2 , Monika Beles  1 , Marc Vanderheyden  1 , Filip Casselman  3 , Tomas Ondrus  1 , Yujing Mo  1 , Frank Van Praet  3 , Martin Penicka  1
Affiliations

Global longitudinal strain and outcome after endoscopic mitral valve repair

Martin Kotrc et al. ESC Heart Fail. 2022 Aug.

Abstract

Aims: Identification of heart failure (HF) patients with secondary mitral regurgitation (SMR) that benefit from mitral valve (MV) repair remains challenging. We have focused on the role of left ventricular global longitudinal strain (LV-GLS) and reservoir left atrial longitudinal strain (LASr) for the prediction of long-term survival and reverse remodelling in patients with SMR undergoing endoscopic MV repair.

Methods and results: The study population consisted of 110 patients (age 67 ± 11 years, 66% men) with symptomatic SMR undergoing isolated MV repair using a minimally invasive surgical approach. Speckle tracking-derived LV-GLS and LASr were assessed in apical views using vendor-independent software. Over a median of 7.7 years (IQRs 2.9-11.2), 64 patients (58%) died. Significant reverse LV (↓ LVESVI >10 mL/m2 ), LA (↓ LAVI >10 mL/m2 ) remodelling or both were observed in 43 (39%), 37 (34%) and 19 (17%) patients, respectively. LV-GLS (HR 0.68, 95% CI 0.58-0.79, P < 0.001) and LASr (HR 0.93, 95% CI 0.88-0.97, P < 0.01) but not LV ejection fraction (LVEF) and LA volume index (LAVi) emerged as independent predictors of all-cause mortality in Cox regression analysis. LV-GLS was the only independent predictor of LV reverse remodelling (OR 1.24, 95% CI 1.05-1.43, P < 0.001) whereas LAVi and LASr were both independent predictors of LA reverse remodelling (both P < 0.05). In patients with atrial fibrillation at baseline, only LASr was an independent predictor (P < 0.05) of LA reverse remodelling.

Conclusions: In patients with SMR undergoing endoscopic MV repair, LV-GLS and LASr are independently associated with long-term survival and reverse remodelling and may be helpful in selecting SMR patients who may benefit from this procedure.

Keywords: Endoscopic mitral valve repair; Reverse remodelling; Secondary mitral regurgitation; Strain; Survival.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Spline and Kaplan–Meier curves for all‐cause mortality according to LV‐GLS (A,B) and LASr (C,D). Prediction of all‐cause mortality across a range of LV‐GLS (A) and LASr (C) using the spline curve. The shadow area represents a 95% confidence interval. Time to all‐cause mortality according to LV‐GLS (B) ≥−7% (red) and <−7 (black). Time to all‐cause mortality according to LASr (D) ≥ 16% (red) and <16 (black).
Figure 2
Figure 2
ROC curve analysis showing the accuracy of LV‐GLS (red solid), LVEF (red dotted), LASr (black solid) and LAVI (black dotted) for predicting 5 year mortality (abbreviations in text).
Figure 3
Figure 3
ROC curve analysis showing the accuracy of LV‐GLS (red solid) and LVEF (red dotted) for predicting LV reverse remodelling (abbreviations in text).
Figure 4
Figure 4
LV volume and LVEF in patients with more preserved (blue bars) versus lower (yellow bars) LV‐GLS at baseline and follow‐up. Patients with more preserved LV‐GLS at baseline showed significant LV reverse remodelling at follow‐up. In contrast, in patients with more impaired LV‐GLS at baseline, LV deteriorated during follow‐up.
See this image and copyright information in PMC

References

    1. Penicka M, Kotrc M, Ondrus T, Mo Y, Casselman F, Vanderheyden M, van Camp G, van Praet F, Bartunek J. Minimally invasive mitral valve annuloplasty confers a long‐term survival benefit compared with state‐of‐the‐art treatment in heart failure with functional mitral regurgitation. Int J Cardiol. 2017; 244: 235–241. - PubMed
    1. Stone GW, Lindenfeld J, Abraham WT, Kar S, Lim DS, Mishell JM, Whisenant B, Grayburn PA, Rinaldi M, Kapadia SR, Rajagopal V, Sarembock IJ, Brieke A, Marx SO, Cohen DJ, Weissman NJ, Mack MJ, COAPT Investigators . Transcatheter mitral‐valve repair in patients with heart failure. N Engl J Med. 2018; 379: 2307–2318. - PubMed
    1. Giannini C, D'Ascenzo F, Fiorelli F, Spontoni P, Swaans MJ, Velazquez EJ, Armeni P, Adamo M, De Carlo M, Petronio AS. A meta‐analysis of MitraClip combined with medical therapy vs medical therapy alone for treatment of mitral regurgitation in heart failure patients. ESC Heart Failure. 2018; 5: 1150–1158. - PMC - PubMed
    1. Bartko PE, Arfsten H, Heitzinger G, Pavo N, Toma A, Strunk G, Hengstenberg C, Hülsmann M, Goliasch G. A unifying concept for the quantitative assessment of secondary mitral regurgitation. J Am Coll Cardiol. 2019; 73: 2506–2517. - PubMed
    1. Obadia JF, Messika‐Zeitoun D, Leurent G, Iung B, Bonnet G, Piriou N, Lefèvre T, Piot C, Rouleau F, Carrié D, Nejjari M, Ohlmann P, Leclercq F, Saint Etienne C, Teiger E, Leroux L, Karam N, Michel N, Gilard M, Donal E, Trochu JN, Cormier B, Armoiry X, Boutitie F, Maucort‐Boulch D, Barnel C, Samson G, Guerin P, Vahanian A, Mewton N. Percutaneous repair or medical treatment for secondary mitral regurgitation. N Engl J Med. 2018; 379: 2297–2306. - PubMed

Publication types