Predictors of Left Ventricular Dysfunction After Surgery for Degenerative Mitral Regurgitation

Area of Science:

• Cardiology
• Cardiac Surgery
• Echocardiography

Background:

• Degenerative mitral regurgitation (DMR) poses challenges in predicting postoperative ventricular dysfunction.
• Left ventricular ejection fraction (LVEF) alone may not fully capture risks in patients undergoing mitral valve surgery.

Purpose of the Study:

• To evaluate if strain measurements can improve the prediction of postoperative ventricular dysfunction in DMR patients.
• To assess the utility of LV, RV, and LA strain in conjunction with LVEF for surgical risk stratification.

Main Methods:

• Analysis of 520 DMR patients undergoing mitral valve surgery (2004-2017).
• Speckle tracking echocardiography used in a subgroup (n=119) to measure LV, RV, and LA strain.
• Multivariate logistic and Cox regression models applied to assess associations with postoperative LV dysfunction and survival.

Main Results:

• Abnormal preoperative strain measurements were significantly linked to developing postoperative LV dysfunction.
• Preoperative strain parameters demonstrated superior predictive capability for LV dysfunction compared to non-strain echocardiographic parameters.
• A significant portion of patients (13.7%) showed reduced LVEF post-discharge, highlighting potential risks.

Conclusions:

• Preoperative strain analysis is a valuable tool for detecting underlying LV dysfunction in DMR patients, even with preserved LVEF.
• Strain measurements offer enhanced predictive power beyond LVEF for identifying patients at risk of postoperative complications.
• Strain analysis may assist in determining the optimal timing for surgical intervention in DMR.