Key result
Severe primary MR is linked to reduced GLS versus controls, indicating subclinical LV dysfunction.
Why the study?
Conventional echocardiographic indices like LVEF may overestimate ventricular performance and fail to detect early myocardial impairment in primary MR.
Does 2DSTE-derived global longitudinal strain (GLS) improve the detection of subclinical left ventricular systolic dysfunction compared to conventional LVEF in patients with severe primary mitral regurgitation and preserved ejection fraction?
Cross-Sectional (n=100)
No
Does 2DSTE-derived global longitudinal strain (GLS) improve the detection of subclinical left ventricular systolic dysfunction compared to conventional LVEF in patients with severe primary mitral regurgitation and preserved ejection fraction?
Effect estimate: null (95% CI null)
Absolute Event Rate: -17.8% vs -21.3%
p-value: p=<0.001
2DSTE-derived global longitudinal strain is a highly sensitive parameter for detecting subclinical left ventricular systolic dysfunction in patients with severe primary mitral regurgitation and preserved ejection fraction, outperforming conventional LVEF.
GLS may allow earlier LV dysfunction detection than LVEF in severe primary MR; extends evidence but leaves open whether GLS-guided management improves outcomes.
Background and Aim: Primary mitral regurgitation (MR) is a common valvular disorder with significant long-term morbidity if untreated. Conventional echocardiographic indices, such as left ventricular ejection fraction (LVEF) and chamber dimensions, may overestimate ventricular performance and fail to detect early myocardial impairment. Speckle-tracking echocardiography (STE)–derived global longitudinal strain (GLS) has emerged as a highly sensitive parameter for the detection of subclinical systolic dysfunction. To investigate the role of GLS in the early identification of subclinical LV systolic dysfunction in individuals presenting with severe primary MR and preserved LVEF. Materials and Methods: This study included 100 subjects: 50 with severe MR and normal LVEF, and 50 matched controls. Comprehensive echocardiographic assessment included M-mode, Simpson’s biplane, tissue Doppler imaging, and two-dimensional STE (2DSTE). GLS values were derived from 18 myocardial segments and expressed as a bull’s-eye map. Results: Cases with MR had substantially impaired GLS relative to controls (-17.8±3.1 vs. -21.3±2.1; P < 0.001). All strain parameters were substantially lower among cases. In contrast, LVEF, measured by both M-mode and Simpson’s method, showed no marked variation between groups (P > 0.05). Receiver operating characteristic analysis demonstrated that GLS had superior discriminative performance, with sensitivity of 82% and specificity of 66% at a cut-off of -20.35% (area under the curve 0.821, 95% confidence interval 0.737-0.905, P = 0.001). Conclusion: 2DSTE-derived GLS is an effective parameter for the identification of subclinical LV systolic dysfunction in the context of severe primary MR with preserved EF. Its incorporation into clinical practice may optimize the timing of surgical referral before irreversible myocardial damage occurs.
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Gaballah et al. (2026) conducted a cross-sectional in Primary Mitral Regurgitation (n=100). 2D Speckle-tracking Echocardiography vs. Healthy controls was evaluated on Global longitudinal strain (null, 95% CI null, p=<0.001). Global longitudinal strain in patients with severe primary mitral regurgitation was -17.8, significantly lower than -21.3 in controls (P < 0.001), indicating subclinical left ventricular systolic dysfunction.
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