Predictors of Left Ventricular Dysfunction after Surgery for Degenerative Mitral Regurgitation

Abstract Background This study was performed to determine if strain can supplement the ability of left ventricular ejection fraction (LVEF) to predict post-op ventricular dysfunction in patients undergoing mitral valve (MV) surgery for degenerative mitral regurgitation (DMR). Methods From 2004 to 2017, 520 patients with an LVEF > 60% underwent MV surgery (98% repair) for DMR. All patients had preoperative (pre-op), pre-discharge (pre-dsg) and follow-up (F/U) (mean 5.0±3.6 years) echocardiograms. Speckle tracking was performed in 119/520 (22.9%) patients to determine LV strain, right ventricular (RV) free-wall strain, and left atrial longitudinal strain. Multivariate logistic and Cox regression models were used in this subgroup to evaluate associations with early postoperative LV dysfunction and medium-term overall survival, respectively. Results Median pre-op LVEF of the entire cohort was 65%. Based on pre-dsg echo, 449 patients (86.3%) maintained postoperative LVEF > 50%. 71 patients (13.7%) had a pre-dsg LVEF Conclusions Preoperative strain measurements in DMR patients were significantly associated with superior capabilities of detecting underlying LV dysfunction despite preserved preop LVEF. Strain analysis may serve as another marker for optimal timing of surgical intervention in DMR patients.