Author + information
- Received October 17, 2018
- Revision received February 26, 2019
- Accepted March 14, 2019
- Published online June 12, 2019.
- Yasmine L. Hiemstra, MDa,
- Anton Tomsic, MDb,
- Suzanne E. van Wijngaarden, MDa,
- Meindert Palmen, MD, PhDb,
- Robert J.M. Klautz, MD, PhDb,
- Jeroen J. Bax, MD, PhDa,∗ (, )
- Victoria Delgado, MD, PhDa and
- Nina Ajmone Marsan, MD, PhDa
- aDepartment of Cardiology, Leiden University Medical Center, Leiden, the NetherlandsDepartment of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
- bDepartment of Thoracic Surgery, Leiden University Medical Center, Leiden, the NetherlandsDepartment of Thoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands
- ↵∗Address for correspondence:
Dr. Jeroen J. Bax, Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
Objectives This study sought to investigate whether left ventricular (LV) global longitudinal strain (GLS) is associated with long-term outcome after mitral valve (MV) surgery for primary mitral regurgitation (MR) and assess the differences in outcome according to MR etiology: Barlow’s disease (BD), fibroelastic deficiency (FED), and forme fruste (FF).
Background Appropriate timing of MV surgery for primary MR is still challenging and may differ according to the etiology. In these patients, LV-GLS has been proposed as more sensitive measure to detect subtle LV dysfunction as compared with LV ejection fraction.
Methods 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 (BD, FED, or FF) was defined based on surgical observation. During follow-up, 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 to 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 to 1.11; p < 0.001) and LV-GLS (HR: 1.13; 95% CI: 1.06 to 1.21; p < 0.001) were independently associated with all-cause mortality. Patients with LV-GLS >–20.6% (more impaired) showed significant 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 to 2.86; p = 0.045) and LV-GLS (HR: 1.01; 95% CI: 1.01 to 1.15; p = 0.019) were independently associated with the secondary endpoint.
Conclusions 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. Importantly, patients with BD showed similar prognosis when corrected for age, compared with patients with FED or FF.
- Barlow’s disease
- fibroelastic deficiency
- global longitudinal strain
- primary mitral regurgitation
The Department of Cardiology of Leiden University Medical Centre has received research grants from Biotronik, Medtronic, Boston Scientific, and Edwards Lifesciences. Dr. Bax has received speaker fees from Abbott Vascular. Dr. Delgado has received consulting fees from Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 17, 2018.
- Revision received February 26, 2019.
- Accepted March 14, 2019.
- 2019 American College of Cardiology Foundation
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