Abstract
Purpose: A new indicator of measuring ventricular systolic function is myocardial strain. However, it is unclear if longitudinal strain following mitral valve surgery has any predictive utility in clinical settings. The best time of operation is usually detected through the left ventricular internal dimensions as well as the function.. So this study aimed to evaluate the utility of myocardial strain by echocardiogram with other parameters in forecasting postoperative outcomes after primary MR surgery.
 Methodology: This prospective study enrolled 514 patients (279 males and 235 females; mean age (SD) of male participants was 57.3 (12.9). Included patients had severe primary mitral valve regurgitation and were candidates for valve surgery from April 2018 to April 2022. Patients with combined valvular disease as severe mitral stenosis, redo mitral valve replacement, and previous CABG and ischemic heart disease were excluded. Global longitudinal strain (GLS) was performed. Hospital re-admission for heart failure symptoms, reoperation and mortality were followed up as Cardiac incidents.
 Findings: In median follow-up of about four years, Age, previous ischemia, concomitant CABG, left atrial size, LVEF%, atrial fibrillation and Global longitudinal strain were all predictive of heart incidents. Age, left atrial dimension, and GLS were independent predictors to heart incidents on multivariate analysis (HR: 1.386, 95% CI: 1.083-1.776; P <0.004, HR: 1.003, 95% CI: 0.976-1.031; p value 0.018, HR: 1.192, 95% CI: 1.101-1.291; P <0.001 respectively). All-cause mortality was linked to impaired GLS (HR: 0.003, 95% CI: 0.973-1.102; P =0.039).
 Recommendation: GLS has a substantial link to clinical outcomes and is a stronger forecaster to cardiac issues than standard measurements. Measuring pre-operative GLS among those with severe primary MR is essential for anticipating post-operative results and determining the ideal time to plan operation.
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