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

Esmaeilzadeh, Maryam; Alimi, Hedieh; Hosseini, Saeid; Samiei, Niloofar; Parsaee, Mozhgan

doi:10.5812/rijm.41456

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

Authors

¹ Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran

² Echocardiography Research Center, Quaem Cardiovascular Medical and Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

³ Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran

10.5812/rijm.41456

Abstract

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.

Keywords

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

References

1.Di Dedda U, Pelissero G, Agnelli B, De Vincentiis C, Castelvecchio S, Ranucci M. Accuracy, calibration and clinical performance of the new EuroSCORE II risk stratification system. Eur J Cardiothorac Surg. 2013;43(1):27-32. [PubMed: 22822108]. https://doi.org/10.1093/ejcts/ezs196 PMid:22822108

2. Mor-Avi V, Lang RM, Badano LP, Belohlavek M, Cardim NM, Derumeaux G, et al. Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. Eur J Echocardiogr. 2011;12(3):167-205. [PubMed: 21385887]. https://doi.org/10.1016/j.echo.2011.01.015 PMid:21338865

3. Pu M, Gao Z, Zhang X, Liao D, Pu DK, Brennan T, et al. Impact of mitral regurgitation on left ventricular anatomic and molecular remodeling and systolic function: implication for outcome. Am J Physiol Heart Circ Physiol. 2009;296(6):1727-32. [PubMed: 19329766]. https://doi.org/10.1152/ajpheart.00882.2008 PMid:19329766

4. Grigioni F, Tribouilloy C, Avierinos JF, Barbieri A, Ferlito M, Trojette F, et al. Outcomes in mitral regurgitation due to flail leaflets a multicenter European study. JACC Cardiovasc Imaging. 2008;1(2):133-41. [PubMed: 19356418]. https://doi.org/10.1016/j.jcmg.2007.12.005 PMid:19356418

5. Michelena HI, Bichara VM, Margaryan E, Forde I, Topilsky Y, Suri R, et al. Progress in the treatment of severe mitral regurgitation. Rev Esp Cardiol. 2010;63(7):820-31. [PubMed: 20609316]. https://doi.org/10.1016/S1885-5857(10)70167-5

6. Enriquez-Sarano M, Avierinos JF, Messika-Zeitoun D, Detaint D, Capps M, Nkomo V, et al. Quantitative determinants of the outcome of asymptomatic mitral regurgitation. N Engl J Med. 2005;352(9):875-83. [PubMed: 15745978]. https://doi.org/10.1056/NEJMoa041451 PMid:15745978

7. Rosenhek R, Rader F, Klaar U, Gabriel H, Krejc M, Kalbeck D, et al. Outcome of watchful waiting in asymptomatic severe mitral regurgitation. Circulation. 2006;113(18):2238-44. [PubMed: 16651470]. https://doi.org/10.1161/CIRCULATIONAHA.105.599175 PMid:16651470

8. Blessberger H, Binder T. Two dimensional speckle tracking echocardiography: clinical applications. Heart. 2010;96(24):2032-40. [PubMed: 21088126]. https://doi.org/10.1136/hrt.2010.199885 PMid:21088126

9. Lee R, Marwick TH. Assessment of subclinical left ventricular dysfunction in asymptomatic mitral regurgitation. Eur J Echocardiogr. 2007;8(3):175-84. [PubMed: 17240198]. https://doi.org/10.1016/j.euje.2006.11.002 PMid:17240198

10. Tribouilloy C, Rusinaru D, Szymanski C, Mezghani S, Fournier A, Levy F, et al. Predicting left ventricular dysfunction after valve repair for mitral regurgitation due to leaflet prolapse: additive value of left ventricular end-systolic dimension to ejection fraction. Eur J Echocardiogr. 2011;12(9):702-10. [PubMed: 21821606]. https://doi.org/10.1093/ejechocard/jer128 PMid:21821606

11. Ahmed MI, Gladden JD, Litovsky SH, Lloyd SG, Gupta H, Inusah S, et al. Increased oxidative stress and cardiomyocyte myofibrillar degeneration in patients with chronic isolated mitral regurgitation and ejection fraction >60%. J Am Coll Cardiol. 2010;55(7):671-9. [PubMed: 20170794]. https://doi.org/10.1016/j.jacc.2009.08.074 PMid:20170794 PMCid:PMC3092364

12. Agricola E, Galderisi M, Oppizzi M, Schinkel AF, Maisano F, De Bonis M, et al. Pulsed tissue Doppler imaging detects early myocardial dysfunction in asymptomatic patients with severe mitral regurgitation. Heart. 2004;90(4):406-10. [PubMed: 15020516]. https://doi.org/10.1136/hrt.2002.009621 PMid:15020516 PMCid:PMC1768146

13. de Isla LP, de Agustin A, Rodrigo JL, Almeria C, del Carmen Manzano M, Rodriguez E, et al. Chronic mitral regurgitation: a pilot study to assess preoperative left ventricular contractile function using speckletracking echocardiography. J Am Soc Echocardiogr. 2009;22(7):831-8. [PubMed: 19505795]. https://doi.org/10.1016/j.echo.2009.04.016 PMid:19505795

14. Kim MS, Kim YJ, Kim HK, Han JY, Chun HG, Kim HC, et al. Evaluation of left ventricular short- and long-axis function in severe mitral regurgitation using 2-dimensional strain echocardiography. Am Heart J. 2009;157(2):345-51. [PubMed: 19185644]. https://doi.org/10.1016/j.ahj.2008.10.004 PMid:19185644

15. Matsumura T, Ohtaki E, Tanaka K, Misu K, Tobaru T, Asano R, et al. Echocardiographic prediction of left ventricular dysfunction after mitral valve repair for mitral regurgitation as an indicator to decide the optimal timing of repair. J Am Coll Cardiol. 2003;42(3):458-63. [PubMed: 12906972]. https://doi.org/10.1016/S0735-1097(03)00649-1 PMid:12906972

16. Enriquez-Sarano M, Tajik AJ, Schaff HV, Orszulak TA, McGoon MD, Bailey KR, et al. Echocardiographic prediction of left ventricular function after correction of mitral regurgitation: results and clinical implications. J Am Coll Cardiol. 1994;24(6):1536-43. [PubMed: 7930287]. https://doi.org/10.1016/0735-1097(94)90151-1 PMid:7930287

17. Witkowski TG, Thomas JD, Debonnaire PJ, Delgado V, Hoke U, Ewe SH, et al. Global longitudinal strain predicts left ventricular dysfunction after mitral valve repair. Eur Heart J Cardiovasc Imaging. 2013;14(1):69- 76. Zile MR, Gaasch WH, Carroll JD, Levine HJ. Chronic mitral regurgitation: predictive value of preoperative echocardiographic indexes of left ventricular function and wall stress. J Am Coll Cardiol. 1984;3(2 Pt 1):235-42. [PubMed: 6693615]. https://doi.org/10.1016/S0735-1097(84)80006-6 PMid:6693615

18. Borow KM, Green LH, Mann T, Sloss LJ, Braunwald E, Collins JJ, et al. End-systolic volume as a predictor of postoperative left ventricular performance in volume overload from valvular regurgitation. Am J Med. 1980;68(5):655-63. [PubMed: 7377221]. https://doi.org/10.1016/0002-9343(80)90251-X PMid:7377221

19. Lee R, Haluska B, Leung DY, Case C, Mundy J, Marwick TH. Functional and prognostic implications of left ventricular contractile reserve in patients with asymptomatic severe mitral regurgitation. Heart. 2005;91(11):1407-12. [PubMed: 16230438]. https://doi.org/10.1136/hrt.2004.047613 PMid:16230438 PMCid:PMC1769159

20. Leung DY, Griffin BP, Stewart WJ, Cosgrove DM 3rd, Thomas JD, Marwick TH. Left ventricular function after valve repair for chronic mitral regurgitation: predictive value of preoperative assessment of contractile reserve by exercise echocardiography. J Am Coll Cardiol. 1996;28(5):1198-205. [PubMed: 8890816]. Razavi Int J Med. 2017; 5(1):e41456. 7 Esmaeilzadeh M et al. https://doi.org/10.1016/S0735-1097(96)00281-1 PMid:8890816

21. Haluska BA, Short L, Marwick TH. Relationship of ventricular longitudinal function to contractile reserve in patients with mitral regurgitation. Am Heart J. 2003;146(1):183-8. [PubMed: 12851629]. https://doi.org/10.1016/S0002-8703(03)00173-X PMid:12851629

22. Gulati VK, Katz WE, Follansbee WP, Gorcsan J 3rd. Mitral annular descent velocity by tissue Doppler echocardiography as an index of global left ventricular function. Am J Cardiol. 1996;77(11):979-84. [PubMed: 8644649]. https://doi.org/10.1016/S0002-9149(96)00033-1 PMid:8644649

23. Kjaergaard J, Korinek J, Belohlavek M, Oh JK, Sogaard P, Hassager C. Accuracy, reproducibility, and comparability of Doppler tissue imaging by two high-end ultrasound systems. J Am Soc Echocardiogr. 2006;19(3):322-8. [PubMed: 16500496]. https://doi.org/10.1016/j.echo.2005.10.007 PMid:16500496

24. Ingul CB, Torp H, Aase SA, Berg S, Stoylen A, Slordahl SA. Automated analysis of strain rate and strain: feasibility and clinical implications. J Am Soc Echocardiogr. 2005;18(5):411-8. [PubMed: 15891750]. https://doi.org/10.1016/j.echo.2005.01.032 PMid:15891750

25. Voigt JU, Pedrizzetti G, Lysyansky P, Marwick TH, Houle H, Baumann R, et al. Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. J Am Soc Echocardiogr. 2015;28(2):183-93. [PubMed: 25623220]. https://doi.org/10.1016/j.echo.2014.11.003 PMid:25623220

26. Seo Y, Ishizu T, Aonuma K. Current status of 3-dimensional speckle tracking echocardiography: a review from our experiences. J Cardiovasc Ultrasound. 2014;22(2):49-57. [PubMed: 25031794]. https://doi.org/10.4250/jcu.2014.22.2.49 PMid:25031794 PMCid:PMC4096665

Razavi International Journal of Medicine

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

References

Volume 5, Issue 1
January 2017

Files

Share

How to cite

Statistics

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

References

Volume 5, Issue 1January 2017

Files

Share

How to cite

Statistics

Volume 5, Issue 1
January 2017