Abstract 18171: A Novel Method of Predicting Postoperative Left Ventricular Functions in Patients With Mitral Regurgitation: A Speckle Tracking Study
Aim: Determination of occult left ventricle dysfunction in asymptomatic patients is very important for the timing of operation in patients with mitral regurgitation (MR). It is known that current predictors such as ejection fraction (EF), left ventricle (LV) volume and diameters are not accurate enough. We aim to study the predictive value of preoperative LV torsion for postoperative LV functions by using speckle tracking echocardiography (STE).
Method: 40 severe MR patients with preserved LVEF in sinus rhythm were included in the study. 25 patients underwent mitral valve repair while mitral valve replacement was done in 15. Using STE, preoperative torsion and LV systolic peak global strain were studied. 2D echocardiography was performed for determination of pre- and postoperative LV volumes and ejection fractions.
Results: 13 patients had a postoperative LVEF ≤ 50% (41.9 ± 8.7%) while 27 patients had a LVEF ≥50 % (59.2 ± 5.5%). The postoperative LVEF was similar in the two types of operation (p= 0.7). Preoperative torsion of patients with postoperative EF ≤ 50% was 12.0 ± 4.6° whereas the torsion of patients with preserved postoperative LVEF (i.e. ≥50 %) was 18.6±7.3°. The best discriminant parameter to detect postoperative EF ≥50 % was a torsion cut-off value of 14.0° (area under the receiver operating characteristic curve 0.76, p: 0.006, specificity: 66%; sensitivity: 74%; positive predictive value: 50% and negative predictive value: 84%).
Discussion: We found that preoperative torsion value of >14.0° can predict postoperative preservation of LVEF. By using torsion calculated with STE which is a non-invasive and practical method, it is possible to predict the preservation of LVEF and consequently, postoperative morbidity and prognosis.
- © 2010 by American Heart Association, Inc.