title: Prediction of left ventricular ejection fraction 6 months after surgical correction of organic mitral regurgitation: the value of exercise echocardiography and deformation imaging.
abstract: OBJECTIVE
  Left ventricular (LV) end-systolic diameter and LV ejection fraction (LVEF) are correlated with postoperative LVEF and prognosis in patients with organic mitral regurgitation (MR). However, in some patients, the LVEF does not return to normal 6 months postoperatively, despite normal preoperative diameters. Thus, our study aimed to evaluate whether preoperative LV strain values assessed by echocardiography at rest and during exercise were predictors of postoperative LVEF at 6-month follow-up in patients undergoing surgery for severe organic MR.
  
  
  RESULTS
  In total, 88 patients with severe organic MR (mean age 62.6 ± 1.4 years) were prospectively recruited. All patients underwent an echocardiogram at rest and submaximal exercise (110 ± 10 bpm) prior to surgery and then at rest 6 months after surgery. Exclusion criteria were significant coronary artery disease, other organic valvular diseases, uncontrolled arrhythmia, and haemodynamic instability. Among the 88 patients, 77 had complete data sets with rest and exercise echocardiograms and underwent isolated mitral valve surgery (repaired, n= 72). Global longitudinal strain (GLS) at rest (R= -0.42, P= 0.011) and during exercise (R= -0.36, P= 0.034) correlated with postoperative LVEF. When normalized for LV end-systolic diameter, GLS during exercise was more closely correlated with postoperative LVEF and was its best predictor based on a multivariate linear regression model. At a cut-off of -5.7%/cm, sensitivity was 0.83, specificity 0.70, negative predictive value 0.64, and positive predictive value 0.86 for predicting a 6-month postoperative LVEF of <50%.
  
  
  CONCLUSIONS
  In patients undergoing surgery for severe organic MR, GLS normalized for LV end-systolic diameter at submaximal exercise may be used as a predictor of postoperative LVEF.
authors.affiliation: Department of Cardiology, CIT-IC 804, INSERM U1099 LTSI, Hospital Pontchaillou-University Medical Center, Rue Henri-Le-Guillou, Rennes 35033, France. erwan.donal@chu-rennes.fr
authors.forename: Erwan
authors.initials: E
authors.lastname: Donal
authors.forename: Sophie
authors.initials: S
authors.lastname: Mascle
authors.forename: Anne
authors.initials: A
authors.lastname: Brunet
authors.forename: Christophe
authors.initials: C
authors.lastname: Thebault
authors.forename: Herve
authors.initials: H
authors.lastname: Corbineau
authors.forename: Marcel
authors.initials: M
authors.lastname: Laurent
authors.forename: Alain
authors.initials: A
authors.lastname: Leguerrier
authors.forename: Philippe
authors.initials: P
authors.lastname: Mabo
mesh_terms: D018450:Disease Progression; D005080:Exercise Test; D005260:Female; D006305:Health Status Indicators; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D013223:Statistics as Topic; D013318:Stroke Volume; D013997:Time Factors; D018608:Ultrasonography, Doppler; D016277:Ventricular Function, Left