title: Left ventricular systolic function assessment in secondary mitral regurgitation: left ventricular ejection fraction vs. speckle tracking global longitudinal strain.
abstract: OBJECTIVE
  Left ventricular (LV) ejection fraction (LVEF) is currently considered for the decision making of patients with mitral regurgitation (MR). However, LVEF represents change in LV volume between end-diastole and end-systole but does not characterize the intrinsic function of the myocardium. In contrast, speckle-tracking global longitudinal strain (GLS) characterizes myocardial deformation. The present study evaluated whether LV GLS may detect further impairment in LV systolic function in dilated cardiomyopathy patients with and without severe secondary MR matched based on LVEF.
  
  
  RESULTS
  Patients with non-ischaemic dilated cardiomyopathy (N = 150, 59 ± 12 years old, 58% male) were included: 75 patients with severe secondary MR and 75 patients with none or less than mild MR matched 1 : 1 according to LVEF. The LV systolic function was evaluated by LVEF (following Simpson's biplane method), forward ejection fraction (forward stroke volume relative to LV end-diastolic volume), and speckle-tracking GLS. By definition, LVEF was comparable between the two groups (patients with severe MR 31 ± 10 vs. patients with no/mild MR 31 ± 10%, P = 0.93). However, patients with severe MR had significantly lower forward ejection fraction (29 ± 14 vs. 40 ± 18%, P < 0.001) and more impaired GLS (-8.08 ± 3.33 vs. -9.78 ± 3.78%, P = 0.004) compared with their counterparts. The presence of severe secondary MR was significantly associated with worse LV GLS (β 1.32, 95% confidence interval 0.14-2.49, P = 0.03).
  
  
  CONCLUSIONS
  In patients with severe secondary MR, speckle-tracking GLS shows more deteriorated LV systolic function than LVEF.
authors.affiliation: Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, PO Box 9600, 2300 RC Leiden, The Netherlands Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece.
authors.forename: Vasileios
authors.initials: V
authors.lastname: Kamperidis
authors.affiliation: Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, PO Box 9600, 2300 RC Leiden, The Netherlands.
authors.forename: Nina Ajmone
authors.initials: NA
authors.lastname: Marsan
authors.affiliation: Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, PO Box 9600, 2300 RC Leiden, The Netherlands.
authors.forename: Victoria
authors.initials: V
authors.lastname: Delgado
authors.affiliation: Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, PO Box 9600, 2300 RC Leiden, The Netherlands J.J.Bax@lumc.nl.
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
mesh_terms: D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging / Q000503:physiopathology; D002908:Chronic Disease; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology*; D012189:Retrospective Studies; D013312:Stress, Physiological / Q000502:physiology; D013318:Stroke Volume / Q000502:physiology; D013599:Systole / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016277:Ventricular Function, Left / Q000502:physiology
keywords: Global longitudinal strain; Left ventricular ejection fraction; Severe secondary mitral regurgitation