Role of Speckle Tracking Echocardiography to Predict Left Ventricular Dysfunction Post Mitral Valve Replacement Surgery for Severe Mitral Regurgitation.

Background: Despite improvement in the surgical procedure and strictly following the guidelines for mitral valve replacement (MVR), left ventricular dysfunction still occurs. Novel echocardiographic indices can predict development of LV (left ventricle) dysfunction post MVR. LV-GLS (global longitudinal strain) derived from speckle tracking echocardiography, has been proposed as a novel measure to better depict latent LV dysfunction.

Methods: A total of 100 patients with severe MR (mitral regurgitation) planned for MVR were included. Speckle tracking echocardiography was performed at baseline and at follow up post MVR. ROC (Receiver operating characteristics) curve was plotted to derive the cutoff value of LV-GLS for prediction of LV dysfunction post MVR. Univariate and multi variate regression was analyzed to predict the independent predictors of LV dysfunction after MVR.

Results: LV-GLS was decreased from baseline data (-19.9 vs. -17.7) in patients with LVEF <50% after MVR compared to patients with LVEF≥ 50%. Baseline value of LVESD (35.36 mm vs. 28.23 mm) and LVEDD (49.33 mm vs. 45.10 mm) were significantly higher in patients with LVEF<50% compared to LVEF ≥50% at 3 months follow up. A cutoff value of GLS -19% with sensitivity of 80.3% and specificity of 75.7% was associated in patients with LV dysfunction after MVR. In multivariate regression model GLS < -19% (OR = 21.8, CI:6.61-82.4, P=<0.001) was an independent predictor of LV dysfunction post MVR.

Conclusion: A GLS value of less than -19% was demonstrated as an independent predictor of short term LV dysfunction after mitral valve surgery, LVESD ≥40 mm was also verified additional parameter to predict the LV dysfunction post MVR.