Twist deformation for predicting postoperative left ventricular function in patients with mitral regurgitation: A speckle tracking echocardiography study.

Purpose: Postoperative LV dysfunction is associated with poor prognosis and increased mortality in patient with mitral regurgitation undergoing surgery. With this study, we aimed to investigate the predictive value of classic and speckle tracking echocardiographic (STE) LV deformational parameters for estimating postoperative LV dysfunction.

Methods: Fifty-nine asymptomatic patients with severe mitral regurgitation (MR) due to mitral valve prolapse, who had sinus rhythm and LV ejection fraction (EF) ≥50%, were included. Patients underwent comprehensive and speckle tracking echocardiographic examination before and 6 months after the surgical procedure. Patients were divided into two groups according to postoperative LV function: group A postoperative LV EF≥50% and group B postoperative LV EF<50%.

Results: Patients in group A were found to have higher LV twist (19.7±6.8° vs 11.9±4.2°; P<.001), LV global longitudinal peak strain (GLPS) (-21.7±4 vs -16.5±3.4%; P<.001), and circumferential strain (-19.5±5.2 vs -14.4±5.1%; P=.004) values but lower end-systolic diameter (ESD) (3.2±0.6 vs 4.1±0.9 cm; P<.001) when compared to group B. Multivariate logistic regression analysis revealed that GLPS, ESD, and twist were independent predictors of postoperative LV functions. In the ROC analysis, GLPS ≥18.4% and twist>14.4° predicted postoperative LVEF ≥50%.

Conclusion: GLPS and twist measured by 2DSTE are predictors of LV preservation after surgery in severe MR. These parameters may also be used as prognostic predictors and optimal timing of operation in this patient population.