Mitral annular longitudinal function preservation after mitral valve repair: the MARTE study.

Area of Science:

• Cardiology
• Echocardiography
• Cardiac Surgery

Background:

• Current guidelines for chronic mitral regurgitation (MR) surgery rely on standard echocardiographic indices like left ventricular (LV) ejection fraction (EF).
• LV EF often remains normal until late stages of MR, potentially masking underlying systolic dysfunction.
• This study investigates LV longitudinal systolic function changes post-mitral valve repair in MR patients with normal preoperative EF.

Purpose of the Study:

• To evaluate the impact of mitral valve repair on LV longitudinal systolic function.
• To compare the sensitivity of longitudinal function assessment with EF in detecting surgical benefits.
• To identify more sensitive echocardiographic markers for assessing post-MR surgery outcomes.

Main Methods:

• M-mode mitral lateral annulus systolic excursion (MAPSE) and Tissue Doppler (TD) peak systolic annular velocity (S(m)) were measured.
• 31 patients with moderate to severe MR and normal preoperative EF undergoing mitral valve repair were included.
• Measurements were taken preoperatively and 3 months after surgery.

Main Results:

• Peak systolic annular velocity (S(m)) significantly increased post-surgery (7.8 to 9.6 cm/s).
• Mitral lateral annulus systolic excursion (MAPSE) also significantly increased (1.33 to 1.55 cm).
• Ejection fraction (EF) decreased post-surgery (59.9% to 51.3%), while LV dimensions and volumes reduced.

Conclusions:

• Echocardiographic assessment of LV long axis systolic velocity and excursion is more sensitive than EF for revealing the benefits of MR surgery.
• Longitudinal systolic function parameters offer a more nuanced view of systolic function improvement after mitral valve repair.
• These findings suggest incorporating longitudinal function assessment into routine echocardiographic evaluation post-MR surgery.