Key result
Preoperative global peak atrial longitudinal strain ≤ 21.5% and free wall right ventricular longitudinal strain ≥ -22% predicted heart failure hospitalization and mortality (10 events overall).
Why the study?
A careful preoperative evaluation of patients with mitral regurgitation is pivotal to optimize timing of intervention and clinical outcome, but the prognostic value of speckle tracking echocardiography parameters was not established.
Does preoperative speckle tracking echocardiography (assessing left atrial and right ventricular strain) predict postoperative clinical outcomes in patients with severe mitral regurgitation undergoing surgery?
Cohort (n=110)
Does preoperative speckle tracking echocardiography (assessing left atrial and right ventricular strain) predict postoperative clinical outcomes in patients with severe mitral regurgitation undergoing surgery?
Preoperative speckle tracking echocardiography, specifically combining left atrial and right ventricular strain analysis, provides important prognostic value for clinical outcomes in patients with severe mitral regurgitation referred for surgery.
May support preoperative risk stratification in mitral regurgitation; hypothesis-generating for speckle tracking integration, requiring prospective validation.
BACKGROUND: A careful preoperative evaluation of patients with mitral regurgitation (MR) is pivotal to optimize the timing of intervention and clinical outcome. The aim of this study was to evaluate preoperative prognostic parameters, among basic and speckle tracking echocardiography (STE), in patients undergoing MR surgery. METHODS: We prospectively enrolled patients with severe MR who underwent preoperative clinical, biohumoral and echocardiographic evaluation, before mitral valve surgery. After surgery, patients were followed to investigate clinical outcome. The primary endpoint was a composite of heart failure hospitalizations and all cause-mortality, the secondary endpoint was to identify the best predictors of postoperative functional capacity assessed by New York heart association (NYHA) class. RESULTS: The final study cohort consisted of 110 patients with a mean age of 64 ± 13 years, 59% male. All strain parameters were reduced, while myocardial work (MW) showed normal values. Median follow-up was 17 (10-29) months. The primary endpoint occurred in 10 patients. Two echocardiographic predictors for the primary endpoint were global peak atrial longitudinal strain (PALS) ≤ 21.5% and free wall right ventricular longitudinal strain (fwRVLS) ≥ -22% with ROC curves. The study population was then divided into 3 groups (Group 1, n = 32: PALS>21.5% and fw-RVLS < -22%, Group 2, n = 46: either global PALS or fwRVLS reduced, Group 3, n = 32: PALS ≤ 21.5% and fwRVLS ≥ -22%). Kaplan-Meier curves showed good risk stratification of the composite endpoint across the three groups. Global wasted work(GWW) was an independent predictor of symptoms persistence (NYHA class > II) at follow-up. CONCLUSIONS: STE, particularly with the combination of left atrial and right ventricular strain analysis, can provide additional prognostic value for the preoperative evaluation of patients with MR referred for surgery.
No takes yet. Share an insight, caveat, or question.
Pastore et al. (2026) conducted a cohort in Severe mitral regurgitation undergoing surgery (n=110). Preoperative basic and speckle tracking echocardiography parameters (global PALS and fwRVLS) vs. Normal or reference echocardiographic parameters was evaluated on Composite of heart failure hospitalizations and all cause-mortality. Preoperative global peak atrial longitudinal strain ≤ 21.5% and free wall right ventricular longitudinal strain ≥ -22% predicted heart failure hospitalization and mortality (10 events overall).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: