Introduction:
The optimal timing of mitral valve (MV) surgery in patients with organic mitral regurgitation (OMR) is controversial. The objective of this study was to determine independent predictors of cardiac events in patients with OMR and no triggers for mitral valve surgery.
Hypothesis:
We hypothesized that forward LV ejection fraction (LVEF) calculated by the Dumesnil’s method (i.e. stroke volume measured in LV outflow tract divided by left ventricular end diastolic volume) is superior to the LVEF measured by the biplane Simpson’s method.
Methods:
Two hundred seventy eight patients with OMR (i.e. severity grade ≥1/4) and Doppler echocardiography exam at least 6 months before MV surgery or death were included. Clinical and echocardiographic data of 278 patients with OMR were analyzed retrospectively. The study end-point was the composite of death or need for mitral valve surgery.
Results:
During a mean follow-up of 5.4 ± 3.2 years, there were 147 (53%) events: 96 (35%) mitral surgeries and 66 (24%) deaths. There was no difference in the Simpson LVEF (65 ± 6% vs 65 ± 4%; p=0.86) and global longitudinal strain (-21.18 ± 3.26 % vs -21.26 ± 2.44 %; p=0.86) between patients who had an event versus those who were event-free during follow-up. However, LVEF calculated by Dumesnil’s method at baseline was lower in the event-group (47 ± 15%vs 59 ± 15%; p<0.0001) compared to the non-event group. After adjustment for age, sex, Charlson’s probability, coronary artery disease, ACE inhibitors, β-blockers, diuretics, AF and MR grade, forward LVEF by Dumesnil’s method remained an independent predictor of the occurrence of cardiac events (adjusted hazard ratio: 1.09, 95% interval confidence: 1.02-1.17; p=0.01).
Conclusion:
This study shows that the forward LVEF calculated by the Dumesnil’s method is superior to the standard LVEF or to longitudinal strain to predict outcomes in OMR. These results could help to improve risk stratification of patients with OMR and thereby individualized the treatment’s strategy. Further prospective studies are needed to confirm these findings.
394 Prognostic Value of Global Longitudinal Strain for Individuals with Primary Severe Mitral Regurgitation Undergoing Mitral Valve Surgery: a Systematic Review and Meta-analysis
