Prognostic value of global myocardial constructive work in patients with secondary mitral regurgitation. (25th November 2020)

• Record Type: Journal Article
• Authors: Yedidya, I; Lustosa, R.P; Fortuni, F; Van Der Bijl, P; Namazi, F; Vo, N.M; Ajmone Marsan, N; Delgado, V; Bax, J
• Is Part Of: European heart journal. Volume 41:(2020)Supplement 2
• Publication Date: 2020-11-25
• Subjects: Valvular Heart Disease: Intervention; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/ehjci/ehaa946.1935
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Background: Left ventricular (LV) myocardial contractility evaluation is of crucial importance in patients with secondary mitral regurgitation (SMR). The most widespread echocardiographic tool, left ventricular ejection fraction (LVEF), might overestimate LV function, since it calculates the volume changes regardless of the flow direction. Global myocardial constructive work (GMCW) might be a more suitable tool, as LV myocardial work derived from pressure-strain loops obtained with speckle tracking echocardiography incorporates non-invasive blood pressure measurements. Purpose: To evaluate the prognostic value of LV GMCW in patients with SMR. Methods: 378 patients (72% men, median age 68 [range 60 to 74 years]) with various grades of SMR were retrospectively analysed. LV global myocardial constructive work, wasted work and work efficiency were measured with speckle tracking echocardiography. Results: There were 145 patients with mild SMR, 130 with moderate SMR and 103 with severe SMR. Patients with severe SMR had larger LV volumes, lower LVEF and more impaired LV GLS. GMCW was more impaired in patients with severe SMR, compared with mild MR (678 mmHg% vs. 845 mmHg% p<0.001 respectively). After a mean follow-up of 59±37 months, 162 patients died. When dividing the population according to prognostically relevant cut offs derived by spline curve analysis, patients with a GMCW≤700 mmHg% had a worse prognosis, compared with their counterparts (Figure 1). Conclusion: Global myocardial constructive work ≤700 mmHg% is associated with worse long-term survival in patients with SMR. Funding Acknowledgement: Type of funding source: None