Abstract
Recovery of ventricular function after surgical correction of mitral regurgitation (MR) is an important clinical issue. The best timing for mitral valve surgery is sometimes controversial. We studied echocardiographic characteristics of left ventricular (LV) function in 80 patients with severe (regurgitant orifice area ≥ 40 mm 2 ) and preserved ejection fraction (LV EF ≥ 60%) and compared our finding with 30 normal controls similar in age, sex and body mass index. We evaluated the controls and the organic MR patients at rest and during a standardized exercise stress echocardiography. Patients were imaged at rest and after 8 minutes of sub maximal exercise (heart rate [100–120 b/m]. All the echocardiographies were prospectively performed by the same team, the same echo-machine and protocol. It provided conventional echocardiographic indices but also new ones like the global longitudinal strain. The LV volume were significantly larger in the MR group (diastolic: 134 ± 39 ml vs 69 ± 21; p < 0.001; systolic 43 ± 16 vs 25 ± 9 ml, p < 0.001). At rest, the EF was 68 ± 7% in MR group vs 65 ± 6 in the controls (p = 0.005). E/e’ was 13 ± 6 vs 10 ± 2; p = 0.007; the global longitudinal strain (GLS) was 18 ± 4% vs 21 ± 3; p 0.001. During the exercise, the evolution of the GLS was clearly different in the MR group versus the controls. A slight or no increase in GLS was observed in the MR group: 19 ± 8%. In opposite, the control's GLS improved: 26 ± 3% during the exercise; p < 0.001. If we considered GLS indexed to LV end diastolic volume, the difference in GLS was even greatest. In comparison, exercise EF was none significantly different between groups (MR group 72 ± 9% vs 75 ± 7 controls, P = 0.07). Independently of the LV geometry changes, GLS appears to be a promising new index of LV systolic function in MR patients. Better than EF, especially during an exercise, GLS performed highly better than EF distinguishing LV characteristics of patients with a significant severe MR vs. controls. GLS might have to be tested to best select MR patients justifying an early repair to protect LV systolic competence.
Published Version
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