title: Left ventricular remodeling and mitral valve surgery: prospective study with real-time 3-dimensional echocardiography and speckle tracking.
abstract: OBJECTIVE
  The aim of the present study was the assessment of left ventricular (LV) remodeling during the surgical management of degenerative mitral valve regurgitation (DMR) with the application of 2 emerging imaging modalities: real-time 3-dimensional echocardiography (3DE) and speckle tracking.
  
  
  METHODS
  A total of 40 patients with DMR were prospectively recruited. Two-dimensional echocardiography, 3DE, and speckle tracking studies were performed before surgery and 6 months postoperatively. The LV volumes, stroke volume, and ejection fraction were calculated. The strain of all myocardial segments, as well as dyssynchrony, was assessed. Receiver operating characteristic curves and regression analysis were used to assess the independent predictors of mitral regurgitation recurrence and LV remodeling.
  
  
  RESULTS
  Of the 40 patients, 21 underwent mitral valve repair and 19 valve replacement. Their mean age was 59.5 ± 15.4 years. The postoperative LV 3DE analysis revealed a significant reduction in LV end-diastolic volume (103.9 cm(3) from 165.2 cm(3) preoperatively, P < .001). A synchronous decrease in the LV end-diastolic diameter (48 mm from 53.5 mm preoperatively, P < .001) and left atrial diameter (42.8 mm from 53.1 mm preoperatively, P = .005) were identified after DMR surgery. Regression analysis demonstrated incremental favor toward mitral valve repair in reverse ventricular remodeling. Independent factors were identified for regurgitation recurrence after surgery. The most significant were late diastolic (A') wave of the septal apical wall of < 3.2 cm/s (area under the curve [AUC], 0.82), late diastolic (A') wave of the mid-septal wall of ≤ 3.66 cm/s (AUC, 0.82), mid-lateral radial strain of ≤ -27 (AUC, 0.81), and apical lateral radial strain of ≤ -25 (AUC, 0.80).
  
  
  CONCLUSIONS
  3DE and speckle tracking proved to be important imaging tools in assessing reverse LV remodeling after DMR surgery. Subtle regional preoperative changes in diastolic function of the septal and lateral wall could be identified preoperatively, aiding in optimizing the referral timing and recognizing potential culprits as indicators of disease recurrence after mitral repair.
authors.affiliation: Department of Cardiovascular Sciences, National Heart and Lung Institute, Imperial College, London, United Kingdom.
authors.forename: Dimosthenis
authors.initials: D
authors.lastname: Pandis
authors.forename: Julia
authors.initials: J
authors.lastname: Grapsa
authors.forename: Thanos
authors.initials: T
authors.lastname: Athanasiou
authors.forename: Prakash
authors.initials: P
authors.lastname: Punjabi
authors.forename: Petros
authors.initials: P
authors.lastname: Nihoyannopoulos
mesh_terms: D000328:Adult; D000368:Aged; D015150:Echocardiography, Doppler / Q000379:methods*; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000601:surgery*; D011184:Postoperative Period; D011446:Prospective Studies; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging; D020257:Ventricular Remodeling