title: Chronic mitral regurgitation: a pilot study to assess preoperative left ventricular contractile function using speckle-tracking echocardiography.
abstract: BACKGROUND
  The development of postoperative left ventricular (LV) dysfunction is a frequent complication in patients with chronic severe mitral regurgitation (MR) and implies a poor prognosis. The aim of this study was to evaluate the predictive value of preoperative regional LV contractile function assessment using two-dimensional echocardiography-based speckle-tracking analysis in patients with chronic severe MR.
  
  
  METHODS
  Thirty-eight consecutive patients with chronic severe MR scheduled for mitral valve replacement were prospectively enrolled. Preoperative two-dimensional echocardiography-based speckle-tracking analysis at the level of the interventricular septum (IVS) was carried out, and strain and strain rate values were obtained. LV dP/dt and Doppler tissue imaging-derived strain and strain rate measurements were also obtained. LV volumes and LV ejection fraction (LVEF) were defined using three-dimensional echocardiography.
  
  
  RESULTS
  Preoperative speckle tracking-derived longitudinal strain and strain rate values at the level of the IVS strongly predicted a postoperative LVEF decrease of >10%. Their predictive values were greater than those obtained for preoperative LV volumes and LVEF, LV dP/dt, and Doppler tissue imaging-derived strain and strain rate. The best discriminant parameter to detect a postoperative LVEF reduction of >10% with speckle tracking was a longitudinal strain rate at the level of the mid IVS < -0.80 s(-1) (area under the receiver operating characteristic curve, 0.88; sensitivity, 60%; specificity, 96.5%; positive predictive value, 90%; negative predictive value, 82.35%).
  
  
  CONCLUSIONS
  IVS longitudinal speckle tracking-derived strain rate allows the accurate detection of early abnormalities in LV contractile function. It is a powerful predictor of early postoperative LVEF decreases in patients with chronic severe MR. Furthermore, speckle-tracking technology is more accurate than other methods. This new tool might assist clinicians in the optimal timing of surgery in patients with chronic severe MR.
authors.affiliation: Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Leopoldo Perez
authors.initials: LP
authors.lastname: de Isla
authors.forename: Alberto
authors.initials: A
authors.lastname: de Agustin
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Rodrigo
authors.forename: Carlos
authors.initials: C
authors.lastname: Almeria
authors.forename: Maria
authors.initials: M
authors.lastname: del Carmen Manzano
authors.forename: Enrique
authors.initials: E
authors.lastname: Rodríguez
authors.forename: Ana
authors.initials: A
authors.lastname: García
authors.forename: Carlos
authors.initials: C
authors.lastname: Macaya
authors.forename: José
authors.initials: J
authors.lastname: Zamorano
mesh_terms: D000465:Algorithms; D002908:Chronic Disease; D015150:Echocardiography, Doppler / Q000379:methods*; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications* / Q000000981:diagnostic imaging* / Q000601:surgery; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000000981:diagnostic imaging* / Q000601:surgery