Key result
Severe secondary MR is linked to ~1.3-point worse GLS in LVEF-matched patients.
Why the study?
LVEF is used for decision making in MR but does not characterize intrinsic myocardial function, whereas GLS may detect further LV systolic impairment.
Does speckle-tracking GLS detect further impairment in LV systolic function compared to LVEF in dilated cardiomyopathy patients with severe secondary MR?
Observational (n=150)
Does speckle-tracking GLS detect further impairment in LV systolic function compared to LVEF in dilated cardiomyopathy patients with severe secondary MR?
Speckle-tracking GLS reveals worse intrinsic myocardial function in patients with severe secondary MR compared to matched patients without severe MR, highlighting the limitations of LVEF in this population.
GLS may unmask systolic dysfunction missed by LVEF in severe secondary MR; leaves open its role in risk stratification for nonischemic cardiomyopathy.
AIMS: Left ventricular (LV) ejection fraction (LVEF) is currently considered for the decision making of patients with mitral regurgitation (MR). However, LVEF represents change in LV volume between end-diastole and end-systole but does not characterize the intrinsic function of the myocardium. In contrast, speckle-tracking global longitudinal strain (GLS) characterizes myocardial deformation. The present study evaluated whether LV GLS may detect further impairment in LV systolic function in dilated cardiomyopathy patients with and without severe secondary MR matched based on LVEF. METHODS AND RESULTS: Patients with non-ischaemic dilated cardiomyopathy (N = 150, 59 ± 12 years old, 58% male) were included: 75 patients with severe secondary MR and 75 patients with none or less than mild MR matched 1 : 1 according to LVEF. The LV systolic function was evaluated by LVEF (following Simpson's biplane method), forward ejection fraction (forward stroke volume relative to LV end-diastolic volume), and speckle-tracking GLS. By definition, LVEF was comparable between the two groups (patients with severe MR 31 ± 10 vs. patients with no/mild MR 31 ± 10%, P = 0.93). However, patients with severe MR had significantly lower forward ejection fraction (29 ± 14 vs. 40 ± 18%, P < 0.001) and more impaired GLS (-8.08 ± 3.33 vs. -9.78 ± 3.78%, P = 0.004) compared with their counterparts. The presence of severe secondary MR was significantly associated with worse LV GLS (β 1.32, 95% confidence interval 0.14-2.49, P = 0.03). CONCLUSION: In patients with severe secondary MR, speckle-tracking GLS shows more deteriorated LV systolic function than LVEF.
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Kamperidis et al. (2015) conducted an observational in Non-ischaemic dilated cardiomyopathy (n=150). Severe secondary mitral regurgitation vs. None or less than mild mitral regurgitation was evaluated on Speckle-tracking global longitudinal strain (GLS) (β 1.32, 95% CI 0.14-2.49, p=0.03). Severe secondary mitral regurgitation was associated with significantly worse global longitudinal strain compared to none/mild MR in LVEF-matched patients (β 1.32; 95% CI 0.14-2.49; P=0.03).
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