title: Predicting outcomes after percutaneous mitral balloon valvotomy: the impact of left ventricular strain imaging.
abstract: OBJECTIVE
  This study aimed (1) to evaluate the impact of preprocedural two-dimensional speckle-tracking echocardiography (2D-STE) on long-term outcome after successful percutaneous mitral balloon valvotomy (PMBV) in patients with mitral stenosis (MS) and (2) to determine whether 2D-STE detects underlying diastolic dysfunction as defined by invasive haemodynamic study.
  
  
  RESULTS
  Sixty-four consecutive MS patients with preserved left ventricular ejection fraction (LVEF ≥50%) and who underwent successfully PMBV were studied. Successful immediate result was defined as post-procedural mitral valve area ≥1.5 cm2 and ≤2/4 mitral regurgitation by catheterization. During a follow-up of 4.2 ± 3.0 years, there were 7 deaths (11%) and 21 late mitral valve reintervention (33%). Univariate predictors of death were global longitudinal strain (GLS), age, LVEF, and pre- and post-procedural pulmonary artery pressures. In the multivariate Cox model, GLS was the strongest predictor of death [hazard ratio (HR) (95% CI), 1.45 (1.07-2.04); P= 0.01]. For the composite endpoint, GLS and post-procedural left atrial pressure (LAP) were univariate predictors of death or reintervention. At multivariable analysis, GLS and post-procedural LAP remained in the final model with strong trend towards significance [GLS HR (95% CI), 1.17 (0.99-1.37); P= 0.056]. There was no correlation between diastolic dysfunction identified at catheterization and standard echocardiographic and 2D-STE indexes, even after adjustments for age, left ventricular mass, effective arterial elastance (afterload), and end-diastolic volume indexes (preload).
  
  
  CONCLUSIONS
  GLS is a powerful predictor of long-term outcome after successful PMBV and provides incremental prognostic value over traditional parameters. Echocardiographic diagnosis of concomitant diastolic dysfunction in MS patients remains elusive.
authors: Sergio
authors: S
authors: Barros-Gomes
authors: Mackram F
authors: MF
authors: Eleid
authors: Jordi S
authors: JS
authors: Dahl
authors: Cristina
authors: C
authors: Pislaru
authors: Rick A
authors: RA
authors: Nishimura
authors: Patricia A
authors: PA
authors: Pellikka
authors: Sorin V
authors: SV
authors: Pislaru
mesh_terms: D000368:Aged; D063126:Balloon Valvuloplasty / Q000379:methods* / Q000401:mortality; D015331:Cohort Studies; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
keywords: diastole; mitral valve; mortality; rheumatic heart disease