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|Title:||Strain Echocardiography and Functional Capacity in Asymptomatic Primary Mitral Regurgitation With Preserved Ejection Fraction|
|Authors:||Mentias, Amgad;Naji, Peyman;Gillinov, A. Marc;Rodriguez, L. Leonardo;Reed, Grant;Mihaljevic, Tomislav;Suri, Rakesh M.;Sabik, Joseph F.;Svensson, Lars G.;Grimm, Richard A.;Griffin, Brian P.;Desai, Milind Y.|
|Keywords:||echocardiography;echocardiography, stress;ejection fraction;exercise;functional capacity;left ventricular ejection fraction;mitral valve insufficiency;mortality vital statistics;operative surgical procedures;posttreatment followup|
|Abstract:||BACKGROUND The potential additive utility of baseline resting left ventricular global longitudinal strain (LV-GLS) and exercise stress testing in risk stratification of patients with significant mitral regurgitation (MR) has not been studied. OBJECTIVE We determined whether resting LV-GLS and exercise testing provide incremental prognostic utility in asymptomatic patients with ≥3+ primary MR, and preserved left ventricular ejection fraction (LVEF). METHODS Between 2000 and 2011, resting and exercise echocardiography data, Society of Thoracic Surgeons (STS) scores, and death were recorded in 737 patients (58 ± 13 years, 68% men). RESULTS Coronary artery disease and flail leaflet were seen in 10% and 28% of patients, respectively. STS score, resting LVEF, mitral effective regurgitant orifice (ERO), resting right ventricular systolic pressure (RVSP), exercise metabolic equivalents (METs) and percentage of age/sex-predicted METs were 1.5 ± 1%, 62 ± 2%, 0.45 ± 0.2 cm(2), 31 ± 12 mm Hg, 9.8 ± 3, and 115 ± 27, respectively. Median LV-GLS was -21.7%. Within 3 (interquartile range: 1 to 15) months, 65% underwent MV surgery. At 8.3 ± 3 years, 64 (9%) patients died (0% 30-day post-operative deaths). On multivariable Cox survival analysis, higher STS score (hazard ratio [HR]: 1.14), more abnormal resting LV-GLS (HR: 1.60), higher baseline RVSP (HR: 1.35), and lower percentage of age/sex-predicted METs (HR: 1.13) were associated with higher mortality, whereas MV surgery (HR: 0.82) was associated with improved survival (all p < 0.01). Addition of predicted METs and resting LV-GLS to STS, resting RVSP, LV end-systolic dimension, and mitral ERO increased the C-statistic for longer-term mortality from 0.61 to 0.69 and 0.78, respectively (all p < 0.01). On quadratic spline analysis, the risk of death progressively increased as resting LV-GLS worsened below -21%. CONCLUSIONS Reduced exercise capacity and worsening resting LV-GLS were associated with mortality, providing additive prognostic utility.|
|Appears in Collections:||Journal of the American College of Cardiology|
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|2016 JACC Volume 68 Issue 18 November (17).pdf||1.71 MB||Adobe PDF|
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