Global longitudinal strain: is it a superior assessment method for left ventricular function in patients with chronic mitral regurgitation undergoing mitral valve replacement?

Singh, Vikas; Kumar, Sarvesh; Bhandari, Monika; Devenraj, Vijayant; Singh, Sushil Kumar

doi:10.1007/s12055-019-00854-7

Cited by 7 publications

(4 citation statements)

References 16 publications

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“…The key findings from the 12 included primary studies are summarized in Table 2. [20][21][22][23][24][25][26][27][28][29][30][31] 3.1 | Correlation between GLS and LVEF Mascle et al 23 concluded GLS to be a predictive factor of postoperative LV dysfunction, (odds ratio (OR) 4.2; [95% confidence interval (CI) 1.4-13], p = .009). 23 Donal et al 22 concluded GLS at rest and during exercise correlated with postoperative LVEF.…”

Section: Resultsmentioning

confidence: 99%

Global longitudinal strain to determine optimal timing for surgery in primary mitral regurgitation: A systematic review

Dona

Afoke

Punjabi

et al. 2021

Journal of Cardiac Surgery

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Background: Primary mitral regurgitation (PMR) results in adverse remodeling changes and left ventricular (LV) dysfunction. Assessing LV function has prognostic value in predicting morbidity and mortality. Indications for surgery include parameters such as LV ejection fraction (LVEF) and systolic dimensions. Current guidelines are limited in identifying patients at optimal time for surgery. Impaired postoperative LVEF indicates poor prognostic outcomes and subsequent heart failure. Global longitudinal strain (GLS) via speckle tracking echocardiography (STE) presents as a promising parameter to detect subclinical dysfunction in asymptomatic patients.Methods: Following PRISMA guidelines, a literature search was conducted with Cochrane Library, PudMed, SCOPUS, and Web of Science. Key MeSH terms included "mitral regurgitation," "mitral valve insufficiency," "global longitudinal strain," "deformation," "LV-GLS," and "GLS." Inclusion criteria included (1) patients with severe PMR, (2) mixed population of symptomatic and asymptomatic patients, (3) standardized methods in assessing LV systolic function using 2D-STE, (4) valve repair or replacement surgery, and (5) patient outcomes measured after surgery.Search returned 234 papers, 12 of which met the inclusion criteria and were subsequently reviewed.Results: Baseline GLS is an independent predictor of postoperative outcomes, ranging from −17.9 to −21.7% GLS. A significant negative correlation was observed between preoperative GLS and postoperative LVEF. Impaired baseline GLS was associated with higher mortality rates. Better long-term survival rates were seen in patients who underwent early surgery. Conclusion: GLS shows sensitivity in predicting long-term postoperative outcomes.Further analysis is required to determine preoperative GLS threshold to identify asymptomatic patients at the optimal time for mitral valve surgery.

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Section: Resultsmentioning

confidence: 99%

Global longitudinal strain to determine optimal timing for surgery in primary mitral regurgitation: A systematic review

Dona

Afoke

Punjabi

et al. 2021

Journal of Cardiac Surgery

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“…Previous studies showed that LV longitudinal strain was more reflective for early myocardial dysfunction than LVEF [17]. The study by Mascle et al [18] showed that the LV-GLS threshold of -18% may be related to the occurrence of left ventricular dysfunction after mitral valve surgery.…”

Section: Discussionmentioning

confidence: 97%

Association between Left Ventricular Longitudinal Strain (GLS) and Prognosis of the Patients Undergoing Heart Valve Surgery with Preserved Left Ventricular Ejection Fraction

Xue,

Chen,

Xiao

et al. 2023

HSF

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Purpose: Global longitudinal strain (GLS) seems accurate for detecting subclinical myocardial dysfunction. This study aimed to determine the association between GLS and postoperative intensity of inotropic support in the patients undergoing heart valve surgery with preserved left ventricular ejection fraction. Methods: 74 patients with preserved left ventricular ejection fraction who underwent valve surgery during the period between March 2021 and June 2022 were included in this prospective observational study. Transthoracic echocardiography including strain analysis with speckle tracking was performed before surgery. Patients were stratified according to the left ventricle (LV) GLS: LV-GLS ≥–16% (Impaired GLS group) and LV-GLS <–16% (Normal GLS group). The primary endpoint was postoperative vasoactive inotropic score. A high vasoactive inotropic score (VIS) was defined as a maximum VIS of ≥15 within 24 hours postoperatively. Postoperative adverse events, baseline clinical and echocardiographic data were also recorded. We invested the ability of preoperative GLS in predicting adverse postoperative outcomes, such as prolonged mechanical ventilation and the need for pharmacologic hemodynamic support after cardiac surgery. Results: Seventy-four patients were included and analyzed in this study, including thirty-three in impaired GLS group and forty-one in normal GLS group. In-hospital mortality was 1.27% (1/74). Patients in impaired GLS group were more likely to have prolonged mechanical ventilation (p = 0.041). Multivariable logistic regression analysis revealed that the apical four-chamber view of the left ventricle (A4C)-GLS was significantly associated with high VIS (OR 1.373, p = 0.007). A4C-GLS had a sensitivity of 62.5% and a specificity of 89.66% for predicting high VIS (area under the curve, 0.78). The relationships between GLS and other secondary outcome measures were not statistically significant. The optimal cutoff of A4C-GLS for postoperative high vasoactive inotropic score was –10.85%. Conclusion: Preoperative LV dysfunction is an independent risk factor for postoperative high VIS. A4C-GLS may be a reliable tool in predicting high VIS after cardiac surgery. Those patients with impaired contractility were at high risk for elevated inotropic support and prolonged mechanical ventilation after cardiac surgery. These findings suggest an important role for echocardiographic GLS in perioperative assessment of cardiac function in the patients undergoing cardiac surgery.

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“…An additional complication is that patients still have symptoms of heart failure after surgery. Heart failure after MVR refers to a condition in which the heart cannot effectively pump blood to various parts of the body due to functional problems of the heart after MVR [30,31]. If a patient already has chronic heart disease before surgery, they may still be at risk of heart failure after surgery, as surgery does not always fully correct the structural and functional problems of the heart [32,33].…”

Section: Discussionmentioning

confidence: 99%

Investigation into the early modification of left ventricular mass following mitral valve replacement and the development of a nomogram prediction model

Wu,

Xia,

Wei

et al. 2024

Preprint

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Background Mitral valve disease caused by rheumatic heart disease and mitral valve disease caused by degenerative valvular disease are common types of mitral valve disease. Mitral valve replacement surgery (MVR) is an effective treatment for mitral regurgitation. This study observed the changes of left ventricular mass (LVM) and other indicators through mitral valve lesions caused by different types of lesions, and further observed the changes of LVM and other indicators after MVR. The effects of preoperative LVM and other indicators on postoperative ejection fraction reduction in patients with MVR were described, and the model was established as a risk factor. Method A retrospective study was conducted on the baseline data and perioperative echocardiographic data obtained during hospitalization of 80 patients with rheumatic or degenerative mitral valve disease from September 2022 to March 2023. The patients were divided into two groups, group A and Group B, according to the relevant perioperative indicators obtained by LVM, left ventricular mass index (LVMI) and relative ventricular wall thickness (RWT). Group A (rheumatic heart disease, n = 50) and group B (degenerative valvular disease, n = 30). The changes of left ventricle in two groups were observed. Then, the risk factors affecting the reduction of ejection fraction (EF) 3 months after surgery were screened by univariate and multivariate Logistic regression analysis, and the corresponding risk prediction model was established by using RStudio, and the model was evaluated and verified. Results The preoperative LVM, LVMI, left ventricular volume and left ventricular size in group A were lower than those in group B, and the differences were statistically significant (P < 0.05); The LVM, LVMI, left ventricular volume and left ventricular size of the whole patients at 1 week and 1 month after surgery were all regression compared with those before surgery, and the differences were statistically significant (P < 0.05); There were no significant changes in LVM, left ventricular volume and left ventricular size 3 months after surgery compared with 1 month after surgery (P > 0.05).Logistic regression analysis showed that left atrial diameter and left ventricular end-diastolic diameter, LVM and serum creatinine were independent risk factors for postoperative EF decline (P < 0.05).

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Global longitudinal strain: is it a superior assessment method for left ventricular function in patients with chronic mitral regurgitation undergoing mitral valve replacement?

Cited by 7 publications

References 16 publications

Global longitudinal strain to determine optimal timing for surgery in primary mitral regurgitation: A systematic review

Global longitudinal strain to determine optimal timing for surgery in primary mitral regurgitation: A systematic review

Association between Left Ventricular Longitudinal Strain (GLS) and Prognosis of the Patients Undergoing Heart Valve Surgery with Preserved Left Ventricular Ejection Fraction

Investigation into the early modification of left ventricular mass following mitral valve replacement and the development of a nomogram prediction model

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