The Predictive Value Of Left Ventricular Systolic Function By Two-dimensional Speckle Tracking And Brain Natriuretic Peptide In Patients With Mitral Regurgitation During Perioperative Period

Objective : To investigate the predictive value of left ventricular longitudinal strain and plasma brain natriuretic peptide(BNP)concentration on left ventricular systolic function in patients with severe mitral regurgitation during perioperative period.Methods:Thirty patients with severe mitral regurgitation underwent mitral valve repair or replacement were enrolled for the study.The causes of the mitral disease were ruptured chordae tendineae in 16,mitral valve prolapse in 9,infective endocarditis in 5 cases.Exclusion criteria were preoperative coronary angiography showed coronary stenosis;any wall motion abnormalities on echocardiographic evaluation;combining with other valve heart disease;coronary heart disease;congenital heart disease and cardiomyopathy;severe lung disease or history of infection.According to postoperative left ventricular ejection fraction greater than or equal(group A)to or less than 50%(group B),they were divided into two groups: Group A included patients with postoperative LVEF?50%,n=17,mean age(54.94 ± 10.14),Group B included patients with postoperative LVEF<50%,n=14,mean age(51.30 ± 12.00).Left ventricular global longitudinal strain(GLS)and serum BNP were measured before operation and on the postoperative 7th day.Results were compared and analyzed.1.2 DE conventional ultrasound parameters: left atrium diameter(LAD),left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter (LVESD),left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV)and left ventricular ejection fraction(LVEF)were measured using the Biplane Simpson's method.2.Two-dimensional speckle tracking(2D-STI)measurement parameters: Global and regional longitudinal systolic peak strain(GLS)were measured by automatic functional imaging(AFI)analysis software.3.Plasma brain natriuretic peptide(BNP)concentration: all patients in the preoperative and postoperative 7th morning,plasma BNP value were detected by using chemiluminescence method.Results:1.Two groups of conventional ultrasound parameters comparison Compared with preoperative,LAD,LVEDD,LVEDV,LVEF in two groups decreased significantly(P <0.05),while there were no significant difference between LVESD and LVESV(P >0.05).Compared with Group A,the preoperative LAD,LVEDD,LVEDV and LVESV in Group B were significantly increased(P <0.05),and the levels of LAD,LVEDD and LVEDV also increased after operation(P <0.05).The preoperative LVEF had no significant differences(P> 0.05),but the postoperative LVEF decreased significantly(P<0.05).2.The left ventricular total strain(GLS)in groups A and B were compared The absolute value of GLS on the postoperative 7th day was lower than that in the preoperative level in both two groups.The absolute value of GLS in Group B was lower than that in Group A(P <0.05).3.Plasma BNP concentrations in groups A and B were compared The plasma BNP concentrations of the 7th postoperative plasma were higher than preoperatively in both two groups.Compared with the Group A,the plasma BNP levels in Group B were significantly increased regardless of the preoperative or postoperative(P <0.05).4.The correlation between the postoperative LVEF and preoperative routine ultrasound,LVEF,GLS and plasma BNP There was a negative correlation between postoperative LVEF and preoperative LAD,LVEDD,LVEDV,LVESV and GLS(P <0.05),but no significant correlation with preoperative plasma BNP(P> 0.05).Logistic regression analysis showed preoperative GLS was the independent predictor of postoperative LVEF.ROC curve analysis showed the cut-off value: preoperative GLS =-19.15(area under the curve0.891,sensitivity 84.6%,specificity 72.8%).5.Correlation between postoperative LVEF and postoperative routine ultrasound,GLS and plasma BNP There was a negative correlation between postoperative LVEF and postoperative LAD,LVEDD,LVEDV,BNP and GLS(P <0.05),and positive correlation between GLS and BNP(P <0.05).Logistic regression analysis showed that the predictive value of postoperative LVEF reduction the predictor was GLS.The best cutoff value of ROC curve predicting postoperative LVEF reduction was postoperative GLS =-14.75(area under the curve 0.923,sensitivity 92.3% and specificity 68.8%)Conclusion:1.2D-STI can predict postoperative LVEF reduction at an early stage in severe mitral regurgitation patients.GLS is an independent predictor of early postoperative left ventricular systolic dysfunction in patients with severe mitral regurgitation.2.GLS along with BNP were sensitive parameters of left ventricular systolic function for evaluation the patients with mitral regurgitation during perioperative period.