Page 62 - Advanced echocardiography in characterization and management of patients with secondary mitral regurgitation

Chapter three. Prognostic Value of Left Ventricular Global Longitudinal Strain
prognostic benefit, it remains debatable whether mitral valve intervention at an earlier stage of LV systolic dysfunction could impact outcome (3,13). The results of the current study suggest that LV GLS, likely reflecting LV myocardial damage and fibrosis, is a better prognostic marker than LVEF. LV GLS could therefore aid further risk stratification of patients with secondary MR and help to identify those who will benefit from earlier mitral valve intervention.
Study limitations
The single-center, retrospective nature of this study may limit the generalizability of results; however, it represents a large, unselected cohort. The severity of secondary MR depends on prevailing hemodynamic conditions, but only stable patients were included. It should be acknowledged that LV GLS measurement is vendor-specific, although the difference with other platforms has been demonstrated to be moderate (27). In this study, vendor-specific software was used, and this must be taken into consideration when assessing LV GLS with different software. Quantitative measurements such as effective regurgitant orifice area were only feasible in 67% of the patients; therefore, this parameter was not included in the present analysis.
Conclusions
In patients with significant secondary MR, impaired LV GLS was independently associated with an increased risk of all-cause mortality. LV GLS may therefore be useful in the risk stratification of patients with secondary MR, as well as in the candidate selection and timing of mitral valve intervention.
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