Page 56 - Advanced echocardiography in characterization and management of patients with secondary mitral regurgitation

Chapter three. Prognostic Value of Left Ventricular Global Longitudinal Strain
demonstrating a nonlinear relation of LV GLS vs. all-cause mortality). After an initial plateau and slow rise of HR, there was an increase in the HR for more impaired values of LV GLS (<7.0%) (Figure 2). Based on the spline curve, a value of LV GLS 7.0% was used to dichotomize the population. Patients with more impaired LV systolic function (LV GLS <7.0%) were younger, had more impaired renal function, were more symptomatic (NYHA functional class IV), used less frequently beta-blockers and more often received CRT before invasive mitral valve intervention as compared with patients with more preserved LV systolic function (LV GLS ≥7.0%) (Tables 1, 2, and 3). Patients with more preserved LV GLS (≥7.0%) had a significantly higher prevalence of hypertension. In terms of echocardiographic data, patients with more impaired LV GLS (<7.0%) had significantly larger LV volumes and lower LVEF, compared with the group of patients with more preserved LV GLS (≥7.0%) (Table 2). During follow-up, patients with more preserved LV GLS (≥7.0%) underwent more frequently surgical mitral valve repair with concomitant CABG, whereas those with more impaired LV GLS (<7.0%) were less likely to undergo any invasive mitral valve intervention (Table 3).
Table 2. Echocardiographic Characteristics at Baseline
LVEDVi, ml LVESVi, ml LVEF, %
LV GLS, %
MR grade 2
3
4
LAVI, ml/m2
E′
E/E′ ratio
TR velocity, m/s SPAP, mm Hg
Total Population (N = 650)
107 ± 41
79 ± 37
29 ± 10
7.2 (5.2–9.9)
113 (17) 290 (45) 247 (38) 34 (26–45) 4.5 ± 2.0 25 ± 22
GLS ≥7.0% (n = 349) 92 ± 31
63 ± 27
33 ± 11
9.6 (8.0–11.7)
57 (16)
165 (47) 127 (36) 33 (24–45) 5.0 ± 2.1 23 ± 27 2.6 ± 0.6 39 ± 13
GLS <7.0% (n = 301) 124 ± 45 96 ± 40
23 ± 7
5.1 (3.4–6.0)
56 (19) 125 (42) 120 (40) 35 (27–46) 4.0 ± 1.7 26 ± 16 2.7 ± 0.6 42 ± 14
p Value
<0.001 <0.001 <0.001 <0.001
0.446 0.141 0.362 0.047 <0.001 0.084 0.021 0.020 <0.001
TAPSE, mm
2.7 ± 0.6 40 ± 13 16 ± 5
16 ± 5
Values are mean ± SD, median (interquartile range), or n (%). Patients were divided according to less
15 ± 4
impaired LV GLS (≥7.0%) vs. more impaired LV GLS (<7.0%).
E = peak early diastolic transmitral flow velocity; E▪ = peak early diastolic mitral annular tissue velocity; LAVI = left atrial volume index; LVEDVi = left ventricular end-diastolic volume index; LVEF = left ventricular ejection fraction; LVESVi = left ventricular end-systolic volume index; MR = mitral regurgitation; SPAP = systolic pulmonary artery pressure; TAPSE = tricuspid annular plane systolic excursion; TR = tricuspid regurgitation; other abbreviations as in Table 1.
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