Prognostic of the right ventricular strain in organic mitral regurgitation

Abstract

Organic mitral regurgitation (MR) is a frequent heart valve disease which influences ventricular functions and impacts cardiovascular outcome. Right Ventricular Free Wall Longitudinal Strain (RVLS) is a good prognosticator in heart failure. Hence, we aimed to study its predictive value in organic MR. Two hundred fifty-eight patients (59 ± 15 years, 154 males) with mild to severe organic MR were prospectively enrolled with a complete echocardiography including RV free wall and LV global longitudinal strain assessment. Out of 181 patients with moderate to severe MR, 101 had normal LV and RV function (NoDysf), 40 patients (22%) had an isolated LV dysfunction (≤ −20%, LVdysf), 17 (9%) had an isolated RV dysfunction (≤ −21%, RVdysf), 23 (13%) had a biventricular dysfunction (BiVdysf). Biventricular dysfunction was strongly associated with worse structural (tricuspid annulus diameter: 22.2 ± 3.5 mm/m 2 vs. 19.2 ± 3.5 mm/m 2 , P = 0.0003) and functional RV remodeling (RV fractional shortening: 27.6 ± 9.6% vs. 38.3 ± 11.4%, P < 0.0001, TAPSE: 19.4 ± 5.3 mm vs. 25 ± 4.6 mm, P < 0.0001, tricuspid annular S wave velocity: 12.6 ± 2.9 cm/s vs. 15.5 ± 3.1 cm/s, P = 0.0001) compared with NoDysf. Pulmonary pressure (51.4 ± 20.4 mmHg vs. 39.11 ± 4 mmHg, P = 0.0002) and resistances (Abbas formula: 0.36 ± 0.15 vs. 0.22 ± 0.08, P < 0.0001) were increased in BiVdysf. Forty-nine patients (19%) experienced a cardiovascular events during the follow up period (21.6 ± 14.4 months). At 40 months follow-up, survival free of event was impaired in patients with BiVdysf compared with other groups (Nodysf: 73.2 ± 6%, RVDysf: 70.2 ± 13%, LVDysf: 66 ± 10% and BiVDysf: 41 ± 19%, P = 0.011). In organic MR, we identified by echocardiographic strain modality a sub-group of patients (BiVDysf), which portends a higher cardiovascular risk. The adjunction of RV longitudinal strain assessment in the clinical work-up of these patients could improve the evaluation of cardiovascular risk and may be helpful in the clinical-decision making process.