Global longitudinal strain to determine optimal timing for surgery in primary mitral regurgitation: a systematic review
File(s)
Published version
Author(s)
Modaragamage Dona, Ann Christine
Afoke, Jonathan
Punjabi, Prakash P
Kanaganayagam, Gajen S
Type
Journal Article
Abstract
Background
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.
Methods
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.
Results
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.
Conclusion
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.
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.
Methods
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.
Results
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.
Conclusion
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.
Date Issued
2021-07-01
Date Acceptance
2021-03-14
Citation
Journal of Cardiac Surgery, 2021, 36 (7), pp.2458-2466
ISSN
0886-0440
Publisher
Wiley
Start Page
2458
End Page
2466
Journal / Book Title
Journal of Cardiac Surgery
Volume
36
Issue
7
Copyright Statement
© 2021 The Authors. Journal of Cardiac Surgery Published by Wiley Periodicals LLC
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
License URL
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000634686900001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Subjects
Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Surgery
Cardiovascular System & Cardiology
echocardiography
global longitudinal strain
left ventricular function
primary mitral regurgitation
Publication Status
Published
Date Publish Online
2021-03-30