BACKGROUND
A careful preoperative evaluation of patients with mitral regurgitation (MR) is pivotal to optimize the timing of intervention and clinical outcome. The aim of this study was to evaluate preoperative prognostic parameters, among basic and speckle tracking echocardiography (STE), in patients undergoing MR surgery.
METHODS
We prospectively enrolled patients with severe MR who underwent preoperative clinical, biohumoral and echocardiographic evaluation, before mitral valve surgery. After surgery, patients were followed to investigate clinical outcome. The primary endpoint was a composite of heart failure hospitalizations and all cause-mortality, the secondary endpoint was to identify the best predictors of postoperative functional capacity assessed by New York heart association (NYHA) class.
RESULTS
The final study cohort consisted of 110 patients with a mean age of 64 ± 13 years, 59% male. All strain parameters were reduced, while myocardial work (MW) showed normal values. Median follow-up was 17 (10-29) months. The primary endpoint occurred in 10 patients. Two echocardiographic predictors for the primary endpoint were global peak atrial longitudinal strain (PALS) ≤ 21.5% and free wall right ventricular longitudinal strain (fwRVLS) ≥ -22% with ROC curves. The study population was then divided into 3 groups (Group 1, n = 32: PALS>21.5% and fw-RVLS < -22%, Group 2, n = 46: either global PALS or fwRVLS reduced, Group 3, n = 32: PALS ≤ 21.5% and fwRVLS ≥ -22%). Kaplan-Meier curves showed good risk stratification of the composite endpoint across the three groups. Global wasted work(GWW) was an independent predictor of symptoms persistence (NYHA class > II) at follow-up.
CONCLUSIONS
STE, particularly with the combination of left atrial and right ventricular strain analysis, can provide additional prognostic value for the preoperative evaluation of patients with MR referred for surgery.
M. Pastore, F. Marrese, A. Marchese et al.· International Journal of Car...· 0 citations
Background: It is known that mitral valve surgery produces an early reduction in hemodynamic overload after the procedure. However, the reduction in left ventricular (LV) ejection fraction (EF) may persist over the long term. Speckle-tracking echocardiography (STE) provides more sensitive indices of cardiac performance in MR. Myocardial work (MW) evaluates LV performance by considering the effect of LV afterload. The aim of this study was to describe the acute and late postoperative changes in cardiac function and hemodynamics using STE and MW indices in patients with primary MR and to find echocardiographic predictors of postoperative symptom improvement. Methods: Consecutive patients with severe MR and preserved LV EF undergoing mitral valve repair or replacement were prospectively enrolled. Exclusion criteria were atrial fibrillation, previous cardiac surgery, and concomitant aortic or coronary surgery. Patients underwent clinical, biohumoral and echocardiographic evaluation before surgery and within one week after surgery during the hospitalization period. Then, 32 of them underwent a new echocardiographic exam, completed by MW, at long-term follow-up. Results: Overall, 42 patients were enrolled (mean age 65 ± 12 years, 50% male, mean LV EF 59 ± 4%). After intervention, 48% of patients showed a reduction in LV EF (n = 20), while most patients showed reductions in STE and MW parameters across all chambers. Particularly, the global work index (GWI) was reduced in 79% of patients (n = 33). After a mean long-term follow-up of 26 ± 5 months, all STE parameters significantly improved in >70% of patients (n = 22), while LV EF maintained its initial reduction. A baseline value of LV GLS > −17.7% identified patients with persistence of symptoms at long-term follow-up (AUC 0.68, p = 0.02). Conclusions: After an initial decline, LV function detected by GLS improved over the long term after mitral valve surgery, paralleling a reduction in symptoms. STE indices might provide additional value for the long-term follow-up of patients undergoing mitral valve repair/replacement.
M. Pastore, A. Santoro, Elena Placuzzi et al.· Journal of Clinical Medicine· 0 citations
A multi-chamber strain-based approach may improve HFpEF diagnosis, phenotyping, and risk stratification, supporting a transition toward a more personalized management strategy.
M. Pastore, Clarissa Carmona De Azevedo Bellagamba, A. Stefanini et al.· Journal of Clinical Medicine· 0 citations
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