PREDICTING CHANGE IN MYOCARDIAL FUNCTION IN OBESE, RENAL TRANSPLANT AND T2DM PATIENTS

Abstract

Background: The development of post-operative LV dysfunction in organic, severe mitral regurgitation remains problematic. Myocardial deformation imaging may be used to identify subclinical LV dysfunction in other conditions, so we sought whether it could predict LV deterioration inasymptomatic, severemitral regurgitation (MR). Methods: We studied 40 consecutive patients with normal LV function (ejection fraction; EF> 50%) who had undergone mitral valve repair for MR. All patients underwent pre and post-operative 2D-echocardiography. On the pre-operative studies, longitudinal measures of endocardial and epicardial strain and strain rate (Sendo/epi and SRendo/epi, respectively) were obtained using VectorVelocity Imaging from the three standard apical views. On both preand post-operative studies, end-diastolic and -systolic volumes (EDV and ESV) and EF were measured. Results: MR severity and pre-operative LV dimensions and EF were similar in patients with normal LV function (n= 20) and LV impairment on follow-up (n= 20). Pre-op Sendo and Sepi were significantly decreased in patients with abnormal LV function post-operatively compared to patients with normal LV function in follow-up (Sendo; −14.5± 4.1 vs. −16.9± 3.2, p= 0.04 and Sepi;−13.5± 3.3 vs. −16.7± 5.6, p= 0.04). Sepi weremoderately correlated with post-surgical EDV (R= 0.51, p= 0.001), but Sendo was not (R= 0.33, p= 0.28). Pre-operative Sendo was the only significant predictor of post-op EF (p= 0.035). Sepi had the greatest area under the receiver operator characteristic curves for prediction of impaired LV function at follow-up (0.70, cut-off <−15.1%, sensitivity and specificity of 73% and 65%). Conclusion: Subclinical LV dysfunction may be identified pre-operatively inasymptomatic severeMRusingmyocardial imaging.