Prognostic value of left ventricular strain imaging and brain natriuretic peptide after percutaneous mitral balloon commissurotomy

Abstract

This study aimed (1) to evaluate the impact of pre-procedural two-dimensional speckle-tracking echocardiography (2D-STE) on long-term outcome after successful percutaneous mitral balloon commissurotomy (PMC) in patients with mitral stenosis (MS) and the prognostic value on BNP for restenosis. One hundred and twenty-two consecutive MS patients with preserved left ventricular ejection fraction (LVEF ≥ 50%) and who underwent successfully PMC were studied. Successful immediate result was defined as post-procedural mitral valve area ≥ 1.5 cm 2 and ≤ 2/4 mitral regurgitation by catheterization. During a follow-up of 5.5 ± 2.3.0 years, there were 14 hospitalisations for heart failure (11%) and 22 late mitralvalve reintervention for restenosis (18%) and 21 patients experienced atrial fibrillation (17%). Univariate predictors of heart failure were global longitudinal strain (GLS), age, right ventricular function, left atrial volume, BNP, and pre- and post-procedural pulmonary artery pressures (PAP). In the multivariate Cox model, GLS and PAP were the strongest predictor of HF [hazard ratio (HR) (95% CI), 1.56 (1.03–4.2); P = 0.01 and 1.26 (1.1–12.4); P = 0.02]. For atrial fibrillation and restenosis, LA volume, GLS and post-procedural left atrial pressure (LAP) were univariate predictors’ factors. Multivariable analysis, demonstrated that GLS and LA volume remained in the final model with interesting predictive value [GLS HR (95% CI), 1.27 (0.87–11.72); P = 0.056, 2.66 (1.24–12.44); P = 0.01]. There was no correlation between BNP value and restenosis. GLS and PAP are interesting predictor of long-term outcome after successful PMC and provides incremental prognostic value over traditional parameters. BNP and LA volume provide more informations regarding supraventricular arythmia on the follow-up.