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Prognostic Value of GLS After Surgery for Primary MR
Study Questions:
What is the prognostic value of preoperative left ventricular (LV) global longitudinal strain (GLS) in a large contemporary population of patients who underwent mitral valve (MV) surgery for primary mitral regurgitation (MR)?
Methods:
The investigators identified patients who underwent MV surgery for severe primary MR in their center between 2000 and 2015. Echocardiography was performed in 593 patients (64% men, age 65 ± 12 years) with severe primary MR who underwent MV surgery, including assessment of LV-GLS. The etiology (Barlow’s disease [BD], fibroelastic deficiency [FED], and forme fruste [FF]) was defined based on surgical observation. During follow-up, the primary endpoint was all-cause mortality and a secondary endpoint included cardiovascular death, heart failure hospitalizations, and cerebrovascular accidents.
Results:
During a median follow-up of 6.4 (interquartile range, 3.6-10.4) years, 146 patients died (16 within 30 days after surgery), 46 patients were hospitalized for heart failure, and 13 patients had a cerebrovascular accident. Age (hazard ratio [HR], 1.08; 95% confidence interval [CI], 1.05-1.11; p < 0.001) and LV-GLS (HR, 1.13; 95% CI, 1.06-1.21; p < 0.001) were independently associated with all-cause mortality. Patients with LV-GLS >–20.6% (more impaired) showed significantly worse survival than did patients with LV-GLS ≤–20.6%; of interest, patients with BD showed similar prognosis compared with FED and FF. In addition, previous atrial fibrillation (HR, 1.70; 95% CI, 1.01-2.86; p = 0.045) and LV-GLS (HR, 1.01; 95% CI, 1.01-1.15; p = 0.019) were independently associated with the secondary endpoint.
Conclusions:
The authors concluded that LV-GLS is independently associated with all-cause mortality and cardiovascular events after MV surgery for primary MR and might be helpful to guide surgical timing.
Perspective:
This study reports that LV-GLS is independently associated with all-cause mortality and cardiovascular events in patients undergoing MV surgery for severe primary MR. Furthermore, LV-GLS has incremental prognostic value over clinical risk factors for long-term survival, and when corrected for age, patients with BD showed similar prognosis compared with FED and FF despite more complex MV involvement and challenging MV repair. These data suggest that presence of impaired LV-GLS could possibly lead to early surgery in experienced centers, instead of watchful waiting until overt LV dysfunction develops. In these patients, MV surgery at an early stage might prevent LV dysfunction, possibly irreversible, and subsequent adverse events after surgery. Such a strategy, however, needs to be demonstrated in a prospective study.
Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Valvular Heart Disease, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Acute Heart Failure, Interventions and Imaging, Interventions and Structural Heart Disease, Echocardiography/Ultrasound, Mitral Regurgitation
Keywords: Atrial Fibrillation, Cardiac Surgical Procedures, Diagnostic Imaging, Echocardiography, Heart Failure, Heart Valve Diseases, Mitral Valve Insufficiency, Risk Factors, Secondary Prevention, Stroke, Vascular Diseases
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