Page 55 - Advanced echocardiography in characterization and management of patients with secondary mitral regurgitation

the overall population, while the mean LVEF was 29 ± 10%. The majority of patients (83%) had grade 3 to 4 MR.
Table 1. Clinical Characteristics at Baseline
Age, yrs
Male
BSA, m2
Atrial fibrillation Hypertension
Diabetes mellitus Creatinine level, mmol/l
NYHA functional class I
II III IV
Heart failure etiology Ischemic Nonischemic
Medication Beta-blockers Diuretics
ACE inhibitor/ARB
Total Population (N = 650)
66 ± 11
439 (68)
1.9 ± 0.2
269 (41)
255 (39)
147 (23)
102 (83–133)
32 (5) 156 (24) 386 (59) 76 (12)
340 (52) 310 (48)
455 (70) 543 (84) 529 (81)
GLS ≥7.0% (n = 349) 67 ± 11 225 (65) 1.9 ± 0.2 152 (44) 153 (44) 85 (24)
97 (82–126)
16 (5) 93 (27) 208 (60) 32 (9)
190 (54) 159 (46)
257 (74) 274 (79) 286 (82)
GLS <7.0% (n = 301)
65 ± 11
214 (71)
1.9 ± 0.2
117 (39)
102 (34)
62 (21)
106 (87–142)
16 (5) 63 (21) 178 (59) 44 (15)
150 (50) 151 (50)
198 (66) 269 (89) 243 (81)
p Value
0.009 0.072 0.512 0.227 0.010 0.254 0.002
0.667 0.089 0.905 0.031
0.241 0.241
0.029 <0.001 0.691
Values are mean ± SD, n (%), or median (interquartile range). Patients were divided according to less impaired LV GLS (≥7.0%) vs. more impaired LV GLS (<7.0%).
ACE = angiotensin-converting enzyme; ARB = angiotensin receptor blocker; BSA = body surface area; GLS = global longitudinal strain; LV = left ventricular; NYHA = New York Heart Association.
Follow-up
After a median follow-up of 56 (interquartile range: 28 to 106) months, 334 (51.4%) patients died. Cardiac resynchronization therapy (CRT) was received by 453 (70%) patients (before mitral valve intervention). In 270 (42%) patients, mitral valve intervention was performed after a median follow-up of 35 (interquartile range: 17 to 65) months. Invasive treatment performed after baseline echocardiography is summarized in Table 3.
To investigate the association between LV GLS and all-cause mortality, spline curve analysis was performed. The assumption of linearity for all-cause mortality, predicted from the baseline LV GLS, was not violated (chi-square = 3.0489; p = 0.23) (i.e.,
53
Ch 3