title: Assessment of longitudinal myocardial mechanics in patients with degenerative mitral valve regurgitation predicts postoperative worsening of left ventricular systolic function.
abstract: BACKGROUND
  The optimal timing of mitral valve repair (MVr) in patients with chronic severe degenerative mitral regurgitation (MR) remains controversial and is broadly based on either measurable loss of systolic function, as determined by left ventricular (LV) ejection fraction (LVEF) and/or LV chamber remodeling. The aim of this study was to test the hypothesis that the assessment of LV deformation by speckle-tracking echocardiography might uncover subclinical changes for predicting reduction of LVEF after MVr.
  
  
  METHODS
  One hundred thirty patients (mean age, 57 ± 14 years; 85 men) who underwent MVr for chronic severe degenerative MR were retrospectively identified. Baseline and immediate postoperative transthoracic echocardiography was used to assess global longitudinal strain (GLS), global radial strain, and global circumferential strain before and after MVr.
  
  
  RESULTS
  In comparison with baseline, MVr resulted in significant reductions in LVEF (P < .0001) and in GLS (P < .0001). Postoperative change in LVEF was related to the changes in GLS (r = -0.71, P < .0001) and global circumferential strain (r = -0.22, P = .01) but not global radial strain. For the entire group, the presence of a high preoperative GLS magnitude predicted a postoperative reduction in LVEF of >10% (odds ratio, 0.80; P < .001). Furthermore, GLS showed diagnostic value in predicting a reduction in LVEF of >10% with a resulting postoperative LVEF of <50% (area under the curve, 0.93; P < .001).
  
  
  CONCLUSIONS
  In chronic severe degenerative MR, disproportionately higher LV global longitudinal strain signifies a maladaptive preload-related change that is associated with substantial loss of LVEF immediately after MVr. Preoperative assessment of longitudinal strain may be potentially useful for optimizing the timing of MVr for degenerative MR.
authors.affiliation: Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, New York.
authors.forename: Dimosthenis
authors.initials: D
authors.lastname: Pandis
authors.affiliation: Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, New York.
authors.forename: Partho P
authors.initials: PP
authors.lastname: Sengupta
authors.affiliation: Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, New York.
authors.forename: Javier G
authors.initials: JG
authors.lastname: Castillo
authors.affiliation: Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, New York.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Caracciolo
authors.affiliation: Department of Cardiac Anesthesia, Mount Sinai School of Medicine, New York, New York.
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Fischer
authors.affiliation: Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, New York.
authors.forename: Jagat
authors.initials: J
authors.lastname: Narula
authors.affiliation: Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, New York.
authors.forename: Anelechi
authors.initials: A
authors.lastname: Anyanwu
authors.affiliation: Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, New York. Electronic address: david.adams@mountsinai.org.
authors.forename: David H
authors.initials: DH
authors.lastname: Adams
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D004452:Echocardiography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D011184:Postoperative Period; D012372:ROC Curve; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology*
keywords: Degenerative mitral regurgitation; Left ventricular mechanics; Longitudinal strain; Mitral valve repair; Speckle-tracking