%0 Journal Article
%A Pérez De Isla, Leopoldo
%A De Agustín Loeches, José Alberto
%A Rodrigo López, José Luis
%A Almeria, Carlos
%A Manzano, Maria del Carmen
%A Rodríguez, Enrique
%A García, Ana
%A Macaya Miguel, Carlos
%A Zamorano Gómez, José Luis
%T Chronic Mitral Regurgitation: A Pilot Study to Assess Preoperative Left Ventricular Contractile Function Using Speckle-Tracking Echocardiography
%D 2009
%@ 0894-7317
%U https://hdl.handle.net/20.500.14352/134017
%X Background: The development of postoperative left ventricular (LV) dysfunction is a frequent complication inpatients with chronic severe mitral regurgitation (MR) and implies a poor prognosis. The aim of this study wasto evaluate the predictive value of preoperative regional LV contractile function assessment using two-dimensional echocardiography–based speckle-tracking analysis in patients with chronic severe MR.Methods: Thirty-eight consecutive patients with chronic severe MR scheduled for mitral valve replacementwere prospectively enrolled. Preoperative two-dimensional echocardiography–based speckle-tracking analysis at the level of the interventricular septum (IVS) was carried out, and strain and strain rate values were obtained. LV dP/dt and Doppler tissue imaging–derived strain and strain rate measurements were also obtained.LV volumes and LV ejection fraction (LVEF) were defined using three-dimensional echocardiography.Results: Preoperative speckle tracking–derived longitudinal strain and strain rate values at the level of the IVSstrongly predicted a postoperative LVEF decrease of >10%. Their predictive values were greater than thoseobtained for preoperative LV volumes and LVEF, LV dP/dt, and Doppler tissue imaging–derived strain andstrain rate. The best discriminant parameter to detect a postoperative LVEF reduction of >10% with speckletracking was a longitudinal strain rate at the level of the mid IVS < 0.80 s1 (area under the receiver operatingcharacteristic curve, 0.88; sensitivity, 60%; specificity, 96.5%; positive predictive value, 90%; negativepredictive value, 82.35%).Conclusions: IVS longitudinal speckle tracking–derived strain rate allows the accurate detection of earlyabnormalities in LV contractile function. It is a powerful predictor of early postoperative LVEF decreases inpatients with chronic severe MR. Furthermore, speckle-tracking technology is more accurate than othermethods. This new tool might assist clinicians in the optimal timing of surgery in patients with chronic severeMR. (J Am Soc Echocardiogr 2009;22:831-838.)
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