title: Area strain from 3D speckle-tracking echocardiography as an independent predictor of early symptoms or ventricular dysfunction in asymptomatic severe mitral regurgitation with preserved ejection fraction.
abstract: The indication for surgery in asymptomatic severe mitral regurgitation (SMR) with preserved left ventricular ejection fraction (LVEF) is controversial. We sought to study 3D myocardial mechanics in this population and test 3D-speckle tracking (3DST) parameters as possible predictors of events. 45 asymptomatic patients with SMR and LVEF >60 % and 20 control individuals without cardiac disease underwent 3DST echocardiography. MR group additionally underwent further clinical monitoring. Dyspnea, LVEF under 60 %, or admissions for heart failure were considered as events. When compared with control group, MR group showed lower percentage of global 3D strain, (35.4 ± 9.1 vs. 43.9 ± 10.6; p = 0.003), lower radial strain, lower area change rate and higher end-diastolic volume. In a follow-up time of 23.2 ± 14.5 months we found 15 events (33.3 %). When comparing the remaining patients with this new-onset HF group we found significant differences in longitudinal strain (-17.9 ± 3.3 vs. -15.8 ± 2.1; p = 0.036), area strain (AS) (-48.6 ± 4.6 vs. -43.7 ± 6.2; p = 0.006), circumferential strain (-35.8 ± 4.7 vs. -31.8 ± 6.1; p = 0.034), 3D LVEF (67.1 ± 4.6 vs. 63.0 ± 7.4; p = 0.034) and E/E' index (13.5 ± 3.9 vs. 19.3 ± 9.5; p = 0.006). In multivariate Cox regression AS alone was the only independent predictor. A cutoff value of AS greater than -41.6 % reached a hazard ratio of 4.41 (p = 0.004) for prediction of events. In asymptomatic patients with SMR and preserved ejection fraction, 3DST derived AS is a promising tool for predicting the development of heart failure. This finding may be useful for guiding the selection of patients for early mitral valve repair/replacement surgery even if they are asymptomatic.
authors.affiliation: Cardiac Imaging Unit, Department of Cardiology, Ramón y Cajal University Hospital, Carretera de Colmenar Viejo km 9,100, 28034, Madrid, Spain. ecasasweb@hotmail.com.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Casas-Rojo
authors.affiliation: Cardiac Imaging Unit, Department of Cardiology, Ramón y Cajal University Hospital, Carretera de Colmenar Viejo km 9,100, 28034, Madrid, Spain.
authors.forename: Covadonga
authors.initials: C
authors.lastname: Fernández-Golfin
authors.affiliation: Cardiac Imaging Unit, Department of Cardiology, Ramón y Cajal University Hospital, Carretera de Colmenar Viejo km 9,100, 28034, Madrid, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Moya-Mur
authors.affiliation: Cardiac Imaging Unit, Department of Cardiology, Ramón y Cajal University Hospital, Carretera de Colmenar Viejo km 9,100, 28034, Madrid, Spain.
authors.forename: Ariana
authors.initials: A
authors.lastname: González-Gómez
authors.affiliation: Cardiac Imaging Unit, Department of Cardiology, Ramón y Cajal University Hospital, Carretera de Colmenar Viejo km 9,100, 28034, Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: García-Martín
authors.affiliation: Cardiac Imaging Unit, Department of Cardiology, Ramón y Cajal University Hospital, Carretera de Colmenar Viejo km 9,100, 28034, Madrid, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Morán-Fernández
authors.affiliation: Cardiac Imaging Unit, Department of Cardiology, Ramón y Cajal University Hospital, Carretera de Colmenar Viejo km 9,100, 28034, Madrid, Spain.
authors.forename: Daniel
authors.initials: D
authors.lastname: Rodríguez-Muñoz
authors.affiliation: Cardiac Imaging Unit, Department of Cardiology, Ramón y Cajal University Hospital, Carretera de Colmenar Viejo km 9,100, 28034, Madrid, Spain.
authors.forename: José Julio
authors.initials: JJ
authors.lastname: Jiménez-Nacher
authors.affiliation: Hospital Central de la Defensa, Madrid, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Martí Sánchez
authors.affiliation: Cardiac Imaging Unit, Department of Cardiology, Ramón y Cajal University Hospital, Carretera de Colmenar Viejo km 9,100, 28034, Madrid, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Zamorano Gómez
mesh_terms: D000368:Aged; D058070:Asymptomatic Diseases; D001696:Biomechanical Phenomena; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D018450:Disease Progression; D018572:Disease-Free Survival; D018619:Echocardiography, Doppler, Pulsed; D019560:Echocardiography, Three-Dimensional; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D015999:Multivariate Analysis; D018579:Patient Selection; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013314:Stress, Mechanical; D013318:Stroke Volume; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D016277:Ventricular Function, Left
keywords: 3D speckle-tracking; Area strain; Cardiac mechanics; Echocardiography; Heart failure; Mitral regurgitation