Key result
Higher preinterventional global work index independently predicted a lower risk of postinterventional left ventricular dysfunction (OR 0.995 per 1 mmHg% increment) in patients with primary mitral regurgitation.
Why the study?
Accurate and early identification of impaired LV function is essential for optimal intervention timing in primary mitral regurgitation, and noninvasive myocardial work may provide diagnostic and prognostic utility.
Do preinterventional noninvasive myocardial work parameters predict long-term postinterventional left ventricular dysfunction and clinical outcomes in patients with severe primary mitral regurgitation?
Cohort (n=175)
No
Do preinterventional noninvasive myocardial work parameters predict long-term postinterventional left ventricular dysfunction and clinical outcomes in patients with severe primary mitral regurgitation?
Noninvasive myocardial work parameters, particularly Global Work Index and Global Constructive Work, provide superior risk stratification over standard LVEF for long-term left ventricular dysfunction and adverse clinical events following mitral valve intervention.
May refine preoperative LV dysfunction risk stratification in primary mitral regurgitation; extends strain data but leaves open prospective validation before practice change.
Background Accurate and early identification of impaired left ventricular (LV) function is essential to the optimal timing of intervention for primary mitral regurgitation. Myocardial work derived from noninvasive pressure‐strain loop is a novel and promising afterload‐independent approach to evaluate LV performance. We hypothesized that it may provide diagnostic and prognostic utility in these patients. This study aimed to evaluate myocardial work parameters in patients with significant primary mitral regurgitation, and explore their association with postinterventional LV ejection fraction and clinical composite events. Methods The study prospectively enrolled 180 patients with severe primary mitral regurgitation at baseline and patients were followed up for postinterventional LV function (>12 months) and clinical events (24.0 [23.3–24.6] months). Logistic regression and Cox proportional hazards regression analyses were performed as appropriate. Results Compared with patients exhibiting postinterventional LV ejection fraction ≥50%, individuals with LV ejection fraction <50% demonstrated lower LV global longitudinal strain, global work index (GWI), global constructive work (GCW), and global work efficiency ( P <0.001 for all) and higher global wasted work ( P =0.001). Preinterventional LV global longitudinal strain, GWI, GCW, and global work efficiency were independent predictors of postinterventional LV dysfunction ( P <0.05 for all). The predictive power of logistic regression models comprising LV global longitudinal strain, GWI, and GCW were similar but stronger than the model comprising LV ejection fraction. Preinterventional LV global longitudinal strain, GWI, GCW, and global work efficiency were independently associated with the risk of composite clinical events during follow‐up ( P <0.001 for all). Conclusions Myocardial work parameters, especially GWI, GCW, and global work efficiency, are independent predictors of postinterventional LV dysfunction and are associated with the occurrence of postinterventional clinical composite events.
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Yang et al. (2025) conducted a cohort in Severe primary mitral regurgitation (n=175). Preinterventional Global Work Index (GWI) was evaluated on Postinterventional left ventricular dysfunction (LVEF < 50%) >12 months after intervention (OR 0.995, 95% CI 0.993-0.997, p=<0.001). Higher preinterventional global work index independently predicted a lower risk of postinterventional left ventricular dysfunction (OR 0.995 per 1 mmHg% increment) in patients with primary mitral regurgitation.
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