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Deformation Imaging And Long Term Outcome After Mitral Valve Reconstruction: Preoperative Longitudinal Strain Rate Is A Strong Independent Predictor Of Cardiac Related Morbidity And Mortality

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Deformation imaging and long term outcome after mitral valve reconstruction:
Preoperative longitudinal Strain Rate is a strong independent predictor of cardiac related morbidity and mortality
 
A. Miskovic¹, TD. Poerner ², B. Goebel²,  A. Moritz¹ - (1) Dept. of Cardiac Surgery University Hospital of Frankfurt/Main,, Germany (2) University Hospital Jena, Department of Internal Medicine I,,Jena,Germany

 

 

Purpose:

To evaluate long-term  predictive value of preoperative longitudinal deformation parameters Strain (S) and peak Strain Rate (pSR) and occurrence of LV dysfunction or cardiac events after MVR

 

Methods:

 

Between 2002 and 2004, 95 patients (mean age 63 ± 13y) underwent MVR for severe primary mitral regurgitation in our institution.

 

Echocardiography and tissue doppler derived strain rate imaging (SRI) was performed preoperatively.

 

Off-line analysis in SRI included measurements of peak systolic Strain(S) and peak Strain Rate (pSR), calculated for a 16 segment model and expressed as mean values for the whole LV

 

LV Cardiac events and LV ejection fraction (EF) were recorded during a median follow-up of 10.5 years (5.2 – 11.6

Patient characteristics

§25% of the study group was Asymptomatic.
§Atrial fibrillation was present in 38 (43%),
§Pulm. Hypertension (PAPs>35mmHg) in 48 (53%) patients
 

Results

21 patients died during follow up. Four were lost to FU

Cardiac events were defined as cardiac related or sudden death, incidence of LV dysfunction or decompensation and occurred in  33%  (N= 31) nof the study population.
ROC analysis of pSR provided a cut-off of -1.26(s -¹) for developing cardiac morbidity and mortality with 97% sensitivity and 70% specificity (AUC 0.86 p<0.001, CI 0.77-0.92).
 
The Hazard Ratio for major cardiac events with low global Strain Rate was 8.4 (95% CI: 4.02-17.05, p<0.001)
After adjustment for important clinical and echocardiographic variables at multivariate Cox regression analysis pSR emerged as a strong independent predictor of cardiac events (p<0.0001).
 

Conclusion

 

ØThe association between global longitudinal strain rate and long term cardiac outcome after MVR was independent  of existing risk stratification variables validated by guidelines.
Ø
ØA low pSR (< -1.26) was associate to significantly higher risk of cardiac events during long term follow up, indicating a possible threshold for early operation in patients with uncertain or absent symptoms





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