Prediction of left ventricular systolic function after repair or replacement of mitral regurgitation by two‐dimensional speckle tracking imaging / 中华超声影像学杂志

ABSTRACT

To investigate the predictive value of left ventricular longitudinal strain parameters in patients with severe mitral regurgitation before surgery on the reduction of transthoracic automatic left ventricular three －dimensional ejection fraction ( Heart Model EF ) aftersurgery . Methods Clinical data ,two‐dimensional and three‐dimensional dynamic images of 33 patients preparing for mitral regurgitation surgery and 39 healthy adults were obtained . T wo‐dimensional strain parameters of left ventricular ,and Heart Model EF of left ventricular were obtained by software analysis . Healthy adults were set as control group ,and patients with mitral regurgitation were divided into M R 1 group ( Heart M odel EF did not reduce or decrease ≤ 10% ) and M R2 group ( Heart M odel EF reduced ＞ 10% ) according to the degree of Heart M odel EF reduction 6 months after surgery . Logistic regression analysis was used to evaluate the parameters related to the decrease of Heart Model EF 6 months after operation in the longitudinal strain parameters of left ventricular myocardium before operation ,and the critical values of sensitive predictive parameters were obtained by drawing receiver operating characteristic ( ROC ) curve . Results ①T he absolute values of left ventricular strain parameters in M R 2 group were significantly lower than those in control group and M R1 group ( P ＜ 0 .05 ) . T he results of univariate Logistic regression analysis and ROC curve analysis showed that the left ventricular systolic global peak longitudinal strain ( GLS) ,left ventricular systolic basal peak longitudinal strain ( BLS) and left ventricular systolic inferior wall peak longitudinal strain ( I‐LS) can be used as predictors of post‐operative Heart Model EF reduction ( P ＜0 .05) . T he OR ( 95% CI ) value ,cut‐off value ,sensitivity and specificity were 0 .752 ( 0 .753 ,0 .987 ) ,－19 .35 ,67% ,92% ( GLS) ,0 .757 ( 0 .590 ,0 .970 ) ,－19 .01 ,78% ,77% ( BLS ) and 0 .821 ( 0 .675 ,0 .998 ) ,－18 .43 ,67% ,92% ( I‐LS ) ,respectively . ② T he multivariate logistic regression analysis of left ventricular strain parameters showed that only BLS can be used as predictors of post‐operative EF reduction . T he OR ( 95% CI ) value and P value were 0 .757 ( 0 .590 ,0 .970 ) and 0 .028 , respectively . Conclusions Two‐dimensional speckle tracking imaging has the ability to detect preoperative subclinical left ventricular dysfunction ,and is a reliable reference for selecting surgical timing for patients with severe mitral regurgitation . In addition to left ventricular GLS ,left ventricular BLS and left ventricular I‐LS can also predict postoperative left ventricular dysfunction ,among w hich left ventricular BLS is more significant .