• Rev Esp Cardiol · May 2010

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

    • José A de Agustín, Leopoldo Pérez de Isla, Iván J Núñez-Gil, David Vivas, María del C Manzano, Pedro Marcos-Alberca, Covadonga Fernández-Golfín, Cecilia Corros, Carlos Almería, José L Rodrigo, Adalia Aubele, Dionisio Herrera, Enrique Rodríguez, Carlos Macaya, and José Zamorano.
    • Instituto Cardiovascular, Hospital Clínico San Carlos, Spain. albertutor@hotmail.com
    • Rev Esp Cardiol. 2010 May 1;63(5):544-53.

    Introduction And ObjectivesThe 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.MethodsThis 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.ResultsThe 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.ConclusionsSpeckle-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.

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