title: Changes in left ventricular function after mitral valve repair for severe organic mitral regurgitation.
abstract: BACKGROUND
  Limited data are available on the changes in left ventricular (LV) contractile function at long-term follow-up after mitral valve repair (MVr). Moreover, assessment of LV systolic function in patients undergoing MVr is troublesome with current methods, given that mitral regurgitation is characterized by increased preload and decreased afterload, potentially masking LV dysfunction. The aim of this study was to assess the value of LV global strain (longitudinal and circumferential) measured by speckle tracking analysis for detecting changes in contractile function after MVr.
  
  
  METHODS
  A total of 122 patients with organic mitral regurgitation who underwent successful MVr at an early stage (LV ejection fraction>60%, LV end-systolic diameter<40 mm) were included. Echocardiography was performed at baseline and at short-term (∼7 days) and long-term (1 to 3 years) follow-up after MVr.
  
  
  RESULTS
  At baseline, LV ejection fraction and LV global strain were higher in patients than in 40 normal control individuals. By contrast, LV forward stroke volume was higher in control individuals than in patients. At short-term follow-up, a significant decrease in LV ejection fraction and LV global strain was noted as a consequence of changes in loading conditions. At long-term follow-up, LV ejection fraction and LV global strain improved significantly. Correction of LV strain for LV size showed a subtle impairment of myocardial contractility at baseline, which significantly improved over time after MVr, together with the improvement in LV forward stroke volume.
  
  
  CONCLUSIONS
  Mitral valve repair for organic mitral regurgitation results in a significant increase in LV myocardial contractility as measured by LV global strain corrected by LV size.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Tomasz G
authors.initials: TG
authors.lastname: Witkowski
authors.forename: James D
authors.initials: JD
authors.lastname: Thomas
authors.forename: Victoria
authors.initials: V
authors.lastname: Delgado
authors.forename: Eva
authors.initials: E
authors.lastname: van Rijnsoever
authors.forename: Arnold C T
authors.initials: AC
authors.lastname: Ng
authors.forename: Ulas
authors.initials: U
authors.lastname: Hoke
authors.forename: See H
authors.initials: SH
authors.lastname: Ewe
authors.forename: Dominique
authors.initials: D
authors.lastname: Auger
authors.forename: Kai H
authors.initials: KH
authors.lastname: Yiu
authors.forename: Eduard R
authors.initials: ER
authors.lastname: Holman
authors.forename: Robert J M
authors.initials: RJ
authors.lastname: Klautz
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Schalij
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Nina Ajmone
authors.initials: NA
authors.lastname: Marsan
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000503:physiopathology* / Q000601:surgery*; D011446:Prospective Studies; D012720:Severity of Illness Index; D016277:Ventricular Function, Left