Assessment of myocardial deformation: Predicting medium-term left ventricular dysfunction after surgery in patients with chronic mitral regurgitation

• Published in: Revista española de cardiologia Vol. 63; no. 5; pp. 544 - 553
• Main Authors: de Agustín, José A, Pérez de Isla, Leopoldo, Núñez-Gil, Iván J, Vivas, David, Manzano, María del C, Marcos-Alberca, Pedro, Fernández-Golfín, Covadonga, Corros, Cecilia, Almería, Carlos, Rodrigo, José L, Aubele, Adalia, Herrera, Dionisio, Rodríguez, Enrique, Macaya, Carlos, Zamorano, José
• Format: Journal Article
• Language: English; Spanish
• Published: Spain 01-05-2010
• Subjects: Aged; Cardiac Surgical Procedures; Chronic Disease; Echocardiography, Doppler; Female; Heart Valve Prosthesis Implantation; Humans; Logistic Models; Male; Middle Aged; Mitral Valve Insufficiency - surgery; Myocardium - pathology; Postoperative Complications - diagnostic imaging; Postoperative Complications - etiology; Predictive Value of Tests; Prospective Studies; ROC Curve; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - etiology
• ISSN: 1579-2242
• DOI: 10.1016/S0300-8932(10)70116-0

The development of left ventricular dysfunction after mitral valve replacement is a common problem in patients with chronic severe mitral regurgitation. Assessment of myocardial deformation enables myocardial contractility to be accurately estimated. Our aim was to compare the value of the preoperative strain and strain rate derived by either speckle-tracking echocardiography or tissue Doppler imaging (TDI) for predicting the medium-term decrease in left ventricular ejection fraction (LVEF) following surgery.
This prospective study involved 38 consecutive patients with chronic severe mitral regurgitation who were scheduled for mitral valve replacement. The longitudinal strain and strain rate in the interventricular septum were measured preoperatively using speckle-tracking echocardiography and TDI. The LVEF was determined preoperatively and postoperatively using 3-dimensional echocardiography. Echocardiographic assessments were performed in the 48 hours prior to surgery and 6 months postoperatively.
The patients' mean age was 59.9+/-11.3 years and 10 (29.4%) were male. Both speckle-tracking echocardiography and TDI were found to be predictors of a >10% decrease in LVEF at 6 months. However, the predictive value of speckle-tracking echocardiography was greater than that of TDI. The longitudinal strain at baseline in the interventricular septum as measured by speckle-tracking echocardiography was the most powerful predictor; the area under the curve was 0.85 and the optimal cut-off value was -0.11.
Speckle-tracking echocardiography can be used to predict a decrease in LVEF over the medium term after mitral valve replacement. Moreover, the predictive accuracy of speckle-tracking echocardiography was greater than that of TDI.