Global longitudinal strain to predict left ventricular dysfunction in asymptomatic patients with severe mitral valve regurgitation: literature review

Abstract

The optimal treatment strategy for asymptomatic patients with severe mitral valve regurgitation (MR) and preserved left ventricular (LV) function is challenging. This manuscript reviews the available literature on the value of left ventricular global longitudinal strain (LV-GLS) in predicting LV dysfunction after mitral valve surgery in these patients and discusses its current place in the treatment strategy. Studies were identified from Cochrane Library, SCO-PUS, PubMed and Web of Science up to February 2018. The domain used was MR. The determinant was LV-GLS; other methods of deformation imaging were excluded. The examined outcome was LV dysfunction after surgery. A total of 144 articles were retrieved, of which 11 publications met the inclusion criteria, including a total of 2415 patients. Ten studies showed a significant correlation between preoperative LV-GLS and LV dysfunction postoperatively; one study reported a negative correlation. These studies suggest that LV-GLS is a predictor of LV dysfunction after surgery in asymptomatic patients with chronic MR. Hence, incorporation of LV-GLS for clinical decision-making in these patients might be of additional value. Further research is needed to confirm the role of LV-GLS in postoperative patients, and additionally

Commentary: More insights into the resect versus respect debate: Will we ever have a winner?

“…LV ejection fraction is one of these postoperative parameters, but because of its shortcoming of being loaddependent, LV-GLS has been introduced as another method of assessing LV function. Although LV-GLS measurement is associated with a significant learning curve, 6 it may add important information on LV function, especially in asymptomatic patients 7 and in synergy with other parameters. 8 The use of other potential surrogates of long-term clinical outcomes that require further investigation include biomarkers, LV volume measurements, and modern imaging tools (eg, myocardial fibrosis in magnetic resonance imaging).…”

Looking beyond ejection fraction: what we have in echocardiography

“…Early surgery in severe MR patients is associated with preserved left ventricular function and lower incident heart failure risk (38,39). Bijvoet et al made a literature review about usefulness of LV-GLS in asymptomatic MR patients (40). They found that an impaired LV-GLS (range: -17.9 and -21.7%) is a predictor of both left ventricular dysfunction and an increased mortality (40).…”

An Efficient Techniques used for Diagnosis of Mitral Valve Regurgitation Severity

“…Hebden and Torry [7] projected a method for distinguishing the systolic murmurs arising from aortic stenosis and MV regurgitation by the computation of frequency contents. Bijvoet et al [8] has discussed about the literature survey on optimal strategies for predicting severe mitral valve regurgitation on patients after surgery as well as global longitudinal left ventricular dysfunction. Bruscoand Nazeran [9] discussed an intelligent PDA dependent wearable digital phonocardiograph that could not save the heart sounds; however, diverse signal processing and statistical approaches are employed to segment the signals into a set of four parts, namely, S1, systole, S2 and diastole.…”