Global longitudinal strain by speckle-tracking echocardiography and feature-tracking cardiac magnetic resonance predicting left and right ventricular performance after mitral regurgitation repair

Abstract

Preoperative accurate assessment of biventricular systolic function is, essential for the decision of the operative timing in patients with MR. This study sought to compare the value of 2-dimensional (2D) left ventricular (LV) speckle tracking (STE) and feature tracking (FT) against cardiac magnetic resonance (CMR) LV ejection fraction (EF) on predicting postoperative LV dysfunction and in the other hand, evaluate the remodeling of the RV after mitral valve repair. A total of 85 patients with degenerative mitral regurgitation (57,51±9,96 of age, 21,2% women) underwent LV and RV function assessment using CMR and 2D echocardiography a few days before and 7,7 months after mitral valve repair. Pre- and postoperative indexed LV and RV end-diastolic (EDV), end-systolic volumes (ESV), ejection fraction (EF), Echocardiographic GLS, GCS, and CMR GLS, GCS, GRS were measured. Prior to surgery LV volumes were significantly larger, 2D LV and RV STE and FT lower than normal volunteers. After a median follow-up of 7,7 after mitral repair, not only left and right ventricular volume indexed: LV EDVi, ESVi; RV EDVi, atrial volume but also STE (LVGLS-GCS) and FT (LVGLS, GCS, GRS) were significantly decreased (all P < 0,0001) while RV EF significantly improved ( P :0,01). In univariate analysis, preoperative GLS echo, CS MRI, ESV, and preoperative LV EF were significantly correlated with postoperative LV dysfunction; GLS and LV ESV were independent clinical predictors of postoperative LV dysfunction. 2D LV GLS provides strong additionaL value to predict postoperative LV dysfunction in degenerative mitral regurgitation, with higher predictive value than CMR-LVEF, CMR-FT-LVGLS, or FAC. This supports the use of STE-LVGLS to find the best surgical timing in patients with severe MR to prevent LV dysfunction and allow RV recovery.