Key result
In asymptomatic patients with severe primary mitral regurgitation and preserved ejection fraction, worsening resting left ventricular global longitudinal strain was independently associated with reduced exercise capacity (OR 1.40).
Why the study?
Does resting LV-GLS predict exercise capacity in asymptomatic patients with significant primary mitral regurgitation and preserved LVEF?
Cohort (n=660)
No
Does resting LV-GLS predict exercise capacity in asymptomatic patients with significant primary mitral regurgitation and preserved LVEF?
In asymptomatic patients with severe primary mitral regurgitation and preserved LVEF, resting LV-GLS is independently associated with impaired exercise capacity, suggesting the presence of subclinical LV dysfunction.
Answers are grounded in this paper and cite their sources.
May identify subclinical LV dysfunction in asymptomatic severe primary MR; leaves open whether GLS should guide intervention timing.
BACKGROUND: Despite preserved left ventricular ejection fraction (LVEF), patients with significant primary mitral regurgitation (MR) often have reduced exercise capacity. In asymptomatic patients with ≥3+ primary MR undergoing rest-stress echocardiography (RSE), we sought to evaluate the incremental impact of left ventricular global longitudinal strain (LV-GLS) on exercise capacity. METHODS: ) who underwent RSE at our center between 2001 and 2013 were included. Standard RSE data were obtained. Average resting LV-GLS was measured using Velocity Vector Imaging. Mean metabolic equivalents (METs) and post-stress RVSP were 9.9±3, and 46±15 mmHg; 28% achieved <100% age-gender predicted METs. No patient had ischemia or significant arrhythmias. On logistic regression, resting LV-GLS [odds ratio (OR), 1.40, 95% confidence interval (CI): 1.21-1.55, BMI (OR, 1.11, 95% CI: 1.06-1.17)] and resting RVSP 1.22 (1.02-1.49) were independent predictors of exercise capacity. Area under the curve for association between 100% age-gender predicted METs and various factors were as follows: (I) BMI (0.60, 95% CI: 0.55-0.65, P<0.001); (II) resting RVSP (0.57, 95% CI: 0.52-0.62, P=0.006) and LV-GLS (0.66, 95% CI: 0.61-0.70, P<0.001). CONCLUSIONS: In asymptomatic patients with ≥3+ primary MR, non-dilated LV and preserved LVEF, LV-GLS is independently associated with exercise capacity, beyond known predictors.
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Mentias et al. (2018) conducted a cohort in Asymptomatic primary mitral regurgitation (n=660). Resting left ventricular global longitudinal strain (LV-GLS) was evaluated on Failure to achieve 100% age-gender predicted metabolic equivalents (METs) (OR 1.40, 95% CI 1.21-1.55, p=<0.001). In asymptomatic patients with severe primary mitral regurgitation and preserved ejection fraction, worsening resting left ventricular global longitudinal strain was independently associated with reduced exercise capacity (OR 1.40).
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