Page 59 - Advanced echocardiography in characterization and management of patients with secondary mitral regurgitation

Incremental prognostic value of LV GLS for all-cause mortality
To determine the incremental value of impaired LV GLS (<7.0%) in addition to clinical and conventional echocardiographic parameters, a likelihood ratio test was performed. A baseline model comprised parameters associated with all-cause mortality in univariable Cox regression analysis. After the addition of LVEF ≤30% to the baseline model, no significant increase in the chi-square value was observed (chi-square difference = 0.1; p = 0.443). However, sequential addition of LV GLS <7.0% to the model including baseline parameters and LVEF ≤30% did show a significant increase in the chi-square value (chi- square difference = 3.6; p = 0.024), demonstrating the incremental prognostic value of LV GLS in patients with secondary MR (Figure 4).
Discussion
The present study demonstrated that in patients with secondary MR, impaired LV GLS was independently associated with an increased risk for all-cause mortality, whereas LVEF was not (Central Illustration).
LVEF: Role in prognosis and intervention of secondary MR
According to current guidelines, patients with secondary MR are considered for mitral valve surgery when there is indication for coronary revascularization (3,13). When revascularization is not indicated, LVEF is one of the main variables to weigh
Figure 4. Incremental Value of LV GLS
The incremental value of LV GLS over clinical and traditional echocardio- graphic parameters for the prediction of all-cause mortality. E′ = peak early diastolic mitral annular tissue velocity; LAVI = left atrial volume index; LVEDVi = left ventricular end-diastolic volume index; TAPSE = tricuspid annular plane systolic excursion; other abbreviations as in Figure 1.
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