Abstract 3735: Use of Myocardial Deformation to Predict Follow-up Left Ventricular Function in Asymptomatic Mitral Regurgitation
Background. The management of asymptomatic mitral regurgitation (MR) remains controversial, especially if the mitral valve is not ideal for repair. Contractile reserve (CR) at exercise echo (ExE) can predict LV function in follow-up but may be technically difficult. Myocardial deformation can now be readily measured at rest using speckle tracking; we sought whether this could predict follow-up LV function in MR.
Methods. We studied 69 pts at baseline, 42 of whom proceeded to mitral surgery and 27 of whom remained on medical therapy. All pts underwent myocardial imaging (speckle tracking) for the calculation of strain rate (SR) and strain (ESS). CR at ExE was defined by an increase of EF after stress. Follow-up was performed after 8 months, and pts were divided into those with EF greater or less than 50%.
Results. Areas under the receiver operator characteristic curves for CR, SR and ESS were 0.70, 0.66, 0.74 (p=NS). CR was present in 77% pts, SR >−1 in 76% pts and ESS >−15% in 76% pts. Baseline SR (−1.2+/−0.2 vs −0.9+/−0.1, p=0.05) and ESS (−18+/−3 and 12+/−2, p<0.0001) were significantly different in pts with preserved vs impaired LV function at follow-up. EF >50% at follow-up was present in 46 pts; specificities of CR, SR and ESS for preserved LV function were 60%, 57% and 71%. EF <50% was present in 23 pts, sensitivities of CR, SR and ESS for impaired LV function were 54%, 82% and 77%.
Conclusion. Deformation imaging appears to be as effective as CR for predicting outcome in asymptomatic MR.