title: Preoperative left ventricular function in degenerative mitral valve disease.
abstract: OBJECTIVE
  The aim of the study is to determine the impact of the underlying etiology (Barlow's disease or fibroelastic deficiency) on left ventricular function in patients with degenerative mitral valve disease and severe mitral regurgitation.
  
  
  METHODS
  We studied 233 patients (mean age: 53.8 ± 12.9) undergoing surgery for severe mitral regurgitation due to degenerative mitral valve disease at Almazov Federal Heart Centre between 2009 and 2011. Pathologic diagnoses for valvular tissue specimens were provided by an experienced pathologist. Preoperative strain and strain rate were determined using speckle tracking (Vivid 7 Dimension, EchoPAC'08).
  
  
  RESULTS
  Barlow's disease was identified by the pathologist in 60 patients (25.8%), and fibroelastic deficiency in 173 patients (74.2%). There were no significant differences between groups in preoperative mitral regurgitation volume (70.5 ± 9.6 vs. 71.6 ± 8.5 ml, P = 0.40), and in global systolic (ejection fraction: 52.7 ± 6.6 vs. 52.0 ± 7.4%, P = 0.53) and diastolic (E/e': 12.2 ± 3.9 vs. 12.8 ± 4.2, P = 0.35) left ventricular function. Despite the lack of difference in ejection fraction and diastolic tissue Doppler parameters, in patients with Barlow's disease in comparison with fibroelastic deficiency a significant decrease of the left ventricular longitudinal systolic strain (-13.5 ± 2.2 vs. -15.6 ± 2.3%, P = 0.00001) and early diastolic strain rate (1.04 ± 0.20 vs. 1.14 ± 0.18 s, P = 0.0004) were detected.
  
  
  CONCLUSIONS
  Patients with severe mitral regurgitation due to Barlow's disease have a lower preoperative left ventricular systolic function than those with fibroelastic deficiency, which may affect their postoperative prognosis.
authors.affiliation: aAlmazov Federal Heart, Blood and Endocrinology Centre bSaint-Petersburg State University, Saint-Petersburg, Russia.
authors.forename: Eduard
authors.initials: E
authors.lastname: Malev
authors.forename: Gleb
authors.initials: G
authors.lastname: Kim
authors.forename: Lubov
authors.initials: L
authors.lastname: Mitrofanova
authors.forename: Eduard
authors.initials: E
authors.lastname: Zemtsovsky
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D040181:Genetic Diseases, X-Linked / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D008945:Mitral Valve Prolapse / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D015588:Observer Variation; D057234:Preoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D014463:Ultrasonography; D016277:Ventricular Function, Left / Q000502:physiology*