Faculty of Medicine, Imperial College London, London, UK.
Department of Cardiothoracic Surgery, National Heart and Lung Institute, Imperial College London, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.
J Card Surg. 2021 Jul;36(7):2458-2466. doi: 10.1111/jocs.15521. Epub 2021 Mar 30.
Primary mitral regurgitation (PMR) results in adverse remodeling changes and left ventricular (LV) dysfunction. Assessing LV function has prognostic value in predicting morbidity and mortality. Indications for surgery include parameters such as LV ejection fraction (LVEF) and systolic dimensions. Current guidelines are limited in identifying patients at optimal time for surgery. Impaired postoperative LVEF indicates poor prognostic outcomes and subsequent heart failure. Global longitudinal strain (GLS) via speckle tracking echocardiography (STE) presents as a promising parameter to detect subclinical dysfunction in asymptomatic patients.
Following PRISMA guidelines, a literature search was conducted with Cochrane Library, PudMed, SCOPUS, and Web of Science. Key MeSH terms included "mitral regurgitation," "mitral valve insufficiency," "global longitudinal strain," "deformation," "LV-GLS," and "GLS." Inclusion criteria included (1) patients with severe PMR, (2) mixed population of symptomatic and asymptomatic patients, (3) standardized methods in assessing LV systolic function using 2D-STE, (4) valve repair or replacement surgery, and (5) patient outcomes measured after surgery. Search returned 234 papers, 12 of which met the inclusion criteria and were subsequently reviewed.
Baseline GLS is an independent predictor of postoperative outcomes, ranging from -17.9 to -21.7% GLS. A significant negative correlation was observed between preoperative GLS and postoperative LVEF. Impaired baseline GLS was associated with higher mortality rates. Better long-term survival rates were seen in patients who underwent early surgery.
GLS shows sensitivity in predicting long-term postoperative outcomes. Further analysis is required to determine preoperative GLS threshold to identify asymptomatic patients at the optimal time for mitral valve surgery.
原发性二尖瓣反流（PMR）会导致不良的重构变化和左心室（LV）功能障碍。评估 LV 功能对预测发病率和死亡率具有预后价值。手术指征包括 LV 射血分数（LVEF）和收缩期指标等参数。目前的指南在确定最佳手术时机方面存在局限性。术后 LVEF 受损表明预后不良，并随后导致心力衰竭。通过斑点追踪超声心动图（STE）进行的整体纵向应变（GLS）是一种有前途的参数，可以检测无症状患者的亚临床功能障碍。
根据 PRISMA 指南，通过 Cochrane 图书馆、PudMed、SCOPUS 和 Web of Science 进行文献检索。关键 MeSH 术语包括“二尖瓣反流”、“二尖瓣关闭不全”、“整体纵向应变”、“变形”、“LV-GLS”和“GLS”。纳入标准包括（1）严重 PMR 患者，（2）症状和无症状患者的混合人群，（3）使用 2D-STE 评估 LV 收缩功能的标准化方法，（4）瓣膜修复或置换手术，以及（5）手术后测量的患者结局。检索返回 234 篇论文，其中 12 篇符合纳入标准并随后进行了审查。
基线 GLS 是术后结局的独立预测因子，范围为-17.9%至-21.7% GLS。术前 GLS 与术后 LVEF 呈显著负相关。基线 GLS 受损与更高的死亡率相关。早期手术患者的长期生存率更好。
GLS 在预测长期术后结局方面具有敏感性。需要进一步分析以确定术前 GLS 阈值，以识别二尖瓣手术最佳时机的无症状患者。
