Global and Regional Longitudinal Strains Predict Left Ventricular Dysfunction after Mitral Valve Repair: A Two Dimensional Speckle Tracking Study

Background: It has been well documented that reduced left ventricular ejection fraction (LVEF) has adverse effect on the outcome of patients with severe mitral regurgitation (MR) after mitral valve repair (MVr). However, the best method for early detection of LV dysfunction in asymptomatic or mildly symptomatic patients with MR still has not been established. Recently two dimensional speckle tracking echocardiography (2DSTE) has been used to identify subclinical alterations of myocardial deformation in many clinical settings. Objectives: Our aim was to assess the value of regional and global LV two dimensional strains to predict postoperative LV dysfunction after MVr. Methods: Twenty six patients with severe MR were evaluated. Patients were divided into two groups according to their postoperative LVEF difference, those with a post-op LVEF reduction of < 10% at 3 months (Group 1), and those with post-op LVEF reduction of ≥ 10% at 3 months (Group 2). All data were measured after 3 months follow-up and compared with pre-operative measures. Results: The occurrence of post-operative LV dysfunction was significantly related to left ventricular end-systolic dimension index (LVESDI), NYHA functional class and global longitudinal strain (GLS). A cut-off value of 19% for GLS could predict post-op LV dysfunction with a sensitivity of 89% and specificity of 77%. In addition a cut-off value of 17.7% for long axis strain with a sensitivity of 78% and specificity of 77% and a cut off value of -20% for 2-chamber strain with a sensitivity of 77% and specificity 83% could predict LV dysfunction after MVr. Conclusions: Among all measured data LV global longitudinal strain seems to be the most sensitive predictor of postoperative LV dysfunction in patients with severe MR and normal LVEF after surgical repair.