Key result
Impaired pre-operative LV global work index links to ~194% higher mortality after severe primary MR surgery.
Why the study?
Echocardiography-based left ventricular myocardial work can assess LV function by incorporating LV afterload, but its prognostic value in primary mitral regurgitation undergoing surgery needed evaluation.
Does impaired pre-operative left ventricular global myocardial work index (LVGWI ≤ 1900 mmHg%) predict increased all-cause mortality in patients undergoing surgery for severe primary mitral regurgitation?
Cohort (n=306)
No
Does impaired pre-operative left ventricular global myocardial work index (LVGWI ≤ 1900 mmHg%) predict increased all-cause mortality in patients undergoing surgery for severe primary mitral regurgitation?
Effect estimate: HR 2.94 (95% CI 1.23-7.06)
p-value: p=0.016
Impaired pre-operative left ventricular global myocardial work index (≤ 1900 mmHg%) is independently associated with higher all-cause mortality in patients undergoing surgery for severe primary mitral regurgitation.
Impaired pre-operative LVGWI was associated with higher post-MR surgery mortality; hypothesis-generating and should not yet change practice.
PURPOSE: Echocardiography-based, left ventricular myocardial work (LVMW) can assess LV function by incorporating LV afterload. This study aims to evaluate the prognostic value of LVMW indices in patients with primary mitral regurgitation (MR) undergoing mitral valve surgery. METHODS AND RESULTS: A total of 306 patients (mean age 63 ± 12 years, 68% male) with severe, primary MR who underwent surgery, were included. All patients underwent transthoracic echocardiography and LVMW indices were assessed with commercially available ultrasound equipment before surgery. The mean LV global work index (LVGWI) was 1979 ± 537 mmHg% and 130 (42%) patients had impaired LVGWI (≤ 1900 mmHg%). During a median follow-up of 5.0 years (interquartile range, 2.5-8.9), 27 (8.8%) patients died after mitral valve surgery. Patients with impaired LVGWI or LV global longitudinal strain (LVGLS) (≤ 20%) had lower survival rates compared to the group with preserved (p < 0.01 and p = 0.02, respectively). While the likelihood ratio test suggests that LVGWI ≤ 1900 mmHg% provides additional prognostic information beyond the model including LVGLS (p < 0.05) for all-cause mortality, no significant improvement was observed in area under the curve, the C-index, or net-reclassification index. CONCLUSIONS: In patients with severe, primary MR who underwent surgery, impaired pre-operative LVGWI was associated with a higher mortality risk, and may have incremental value beyond LVGLS, but requires further study for validation.
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Nabeta et al. (2025) conducted a cohort in Severe, primary mitral regurgitation (n=306). Impaired left ventricular global myocardial work index (LVGWI ≤ 1900 mmHg%) vs. Preserved LVGWI (> 1900 mmHg%) was evaluated on All-cause mortality (HR 2.94, 95% CI 1.23-7.06, p=0.016). In patients with severe primary mitral regurgitation undergoing surgery, impaired pre-operative left ventricular global work index was independently associated with higher all-cause mortality (HR 2.94).
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