Department of Cardiology, CIT-IC 804, INSERM U642 LTSI, Hospital Pontchaillou-University Medical Center, Rennes, France.
J Am Soc Echocardiogr. 2012 Jul;25(7):766-72. doi: 10.1016/j.echo.2012.04.009. Epub 2012 May 19.
Because of the lack of reliable echocardiographic parameters to predict recovery after surgery, the optimal timing of surgery for severe mitral regurgitation remains controversial. The aim of this study was to determine whether global longitudinal strain (GLS) recorded preoperatively could help in predicting left ventricular (LV) ejection fraction (LVEF) postoperatively.
A total of 88 patients (mean age, 63 ± 13 years; 59 men) with severe degenerative mitral regurgitation were included prospectively in this study. Rest echocardiography was performed before and 6 ± 1 months after mitral valve surgery. Patients were divided into two groups: group A (postoperative LVEF ≥ 50%) and group B (postoperative LVEF < 50%).
In group B, patients had larger preoperative LV end-systolic diameters (21.6 ± 2.6 vs 19.2 ± 3.7 mm/m(2), P = .02) and impaired preoperative GLS (-17 ± 2.8% vs -19.6 ± 3.6%, P = .01), whereas there was no difference in preoperative LVEF. Preoperative LV end-systolic diameter ≥ 22 mm/m(2) and GLS < -18% were independent predictors of postoperative LV dysfunction.
LV end-systolic diameter is a well-recognized prognostic marker. In addition, this study demonstrates the additive and independent predictive value of preoperative GLS for predicting postoperative LV dysfunction.
由于缺乏可靠的超声心动图参数来预测手术后的恢复情况，因此严重二尖瓣反流的最佳手术时机仍存在争议。本研究旨在确定术前记录的整体纵向应变（GLS）是否有助于预测术后左心室（LV）射血分数（LVEF）。
前瞻性纳入 88 例（平均年龄 63 ± 13 岁；59 名男性）严重退行性二尖瓣反流患者。术前和二尖瓣手术后 6 ± 1 个月进行静息超声心动图检查。患者分为两组：A 组（术后 LVEF≥50%）和 B 组（术后 LVEF<50%）。
在 B 组中，患者术前 LV 收缩末期直径较大（21.6 ± 2.6 比 19.2 ± 3.7 mm/m2，P =.02），术前 GLS 受损（-17 ± 2.8% 比-19.6 ± 3.6%，P =.01），而术前 LVEF 无差异。术前 LV 收缩末期直径≥22 mm/m2 和 GLS<−18%是术后 LV 功能障碍的独立预测因子。
LV 收缩末期直径是公认的预后标志物。此外，本研究表明术前 GLS 对预测术后 LV 功能障碍具有附加的独立预测价值。
