title: Global longitudinal strain predicts left ventricular dysfunction after mitral valve repair.
abstract: OBJECTIVE
  Despite a successful surgical procedure and adherence to current recommendations, postoperative left ventricular (LV) dysfunction after mitral valve repair (MVr) for organic mitral regurgitation (MR) may still occur. New approaches are therefore needed to detect subclinical preoperative LV dysfunction. LV global longitudinal strain (GLS), assessed with speckle-tracking echocardiographic analysis, has been proposed as a novel measure to better depict latent LV dysfunction. The aim of this study was to investigate the value of GLS to predict long-term LV dysfunction after MVr.
  
  
  RESULTS
  A total of 233 patients (61% men, 61 ± 12 years) with moderate-severe organic MR who underwent successful MVr between 2000 and 2009 were included. Echocardiography was performed at baseline and long-term follow-up (34 ± 20 months) after MVr. LV dysfunction at follow-up was defined as LV ejection fraction (EF) <50% and was present in 29 (12%) patients. A cut-off value of -19.9% of GLS showed a sensitivity and specificity of 90 and 79% to predict long-term LV dysfunction. By univariate logistic regression analysis, baseline LVEF ≤60%, LV end-systolic diameter (ESD) ≥40 mm, atrial fibrillation, presence of symptoms, and GLS >-19.9% were predictors of long-term LV dysfunction. By multivariate analysis, GLS remained an independent predictor of LV dysfunction (odds ratio 23.16, 95% confidence interval: 6.53-82.10, P < 0.001), together with LVESD.
  
  
  CONCLUSIONS
  In a large series of patients operated within the last decade, MVr resulted in a low incidence of long-term LV dysfunction. A GLS of >-19.9% demonstrated to be a major independent predictor of long-term LV dysfunction after adjustment for parameters currently implemented into guidelines.
authors: Department of Cardiology,  Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden,  The Netherlands.
authors: Tomasz G
authors: TG
authors: Witkowski
authors: James D
authors: JD
authors: Thomas
authors: Philippe J M R
authors: PJ
authors: Debonnaire
authors: Victoria
authors: V
authors: Delgado
authors: Ulas
authors: U
authors: Hoke
authors: See H
authors: SH
authors: Ewe
authors: Michel I M
authors: MI
authors: Versteegh
authors: Eduard R
authors: ER
authors: Holman
authors: Martin J
authors: MJ
authors: Schalij
authors: Jeroen J
authors: JJ
authors: Bax
authors: Robert J M
authors: RJ
authors: Klautz
authors: Nina Ajmone
authors: NA
authors: Marsan
mesh_terms: D000368:Aged; D000465:Algorithms; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D018450:Disease Progression; D004452:Echocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*