Prediction Of Left Ventricular Systolic Function After Repair Or Replacement Of Mitral Regurgitation By Two-dimensional Speckle Tracking Imaing

Objective:First,to evaluate the changes of left ventricular and left atrial myocardial strain parameters in patients with severe mitral regurgitation before and after surgery by using two-dimensional speckle tracking imaging(STI).Second,Assessment of left ventricular global systolic function by transthoracic automatic three-dimensional echocardiography(Heart Model EF).Finally,analysis of preoperative left heart myocardial strain parameters which can predict global left ventricular systolic dysfunction and poor recovery of cardiac function,and their critical values were calculated to determine the presence of subclinical left ventricular dysfunction in patients with preoperative mitral regurgitation.Methods:Clinical data,two-dimensional and three-dimensional dynamic images of 33 patients preparing for mitral regurgitation surgery and 39 healthy adults were obtained.Two-dimensional strain parameters of left ventricular and left atrial,and Heart model EF of left ventricle were obtained by software analysis.Healthy adults were set as control group,and according to the Heart Model EF value at 6 months after mitral regurgitation surgery,patients with mitral regurgitation were divided into MR1 group of 19 patients with normal recovery of cardiac function after surgery(Heart Model EF value was not reduced or decreased?10%,EF maintained at 60.47±3.37)and MR2 group of 14 patients with poor recovery of cardiac function after surgery(Heart Model EF decreased by>10%,EF maintained at 54.56±4.98).Logistic regression analysis was used to evaluate the longitudinal strain parameters of preoperative left ventricle and left atrial myocardium as predictors of Heart Model EF reduction at 6 months postoperatively.And the critical values of sensitive predictive parameters were obtained by drawing receiver operating characteristic(ROC)curve.Results:? The absolute values of left ventricular strain parameters in MR2 group were significantly lower than those in control group(P<0.05).The results of univariate Logistic regression analysis and ROC curve analysis showed that the left ventricular global longitudinal peak systolic strain(GLS),left ventricular basal longitudinal peak systolic strain(BLS)and left ventricular inferior longitudinal peak systolic strain(I-LS)can be used as predictors of post-operative EF reduction(P<0.05).The OR(95%confidence interval)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.?The left atrial strain parameters were analyzed by univariate logistic regression,and only the longitudinal peak early diastolic strain rate of the basal lateral wall of the left atrial in a apical four chamber view(4LAS-LSRe)reflect to left atrial duct function can be used as predictors of post-operative EF reduction.The OR(95%confidence interval)value and P value were 0.389(0.156,0.967),0.042,respectively.The ROC curve analysis results showed that optimal cut-off value,sensitivity and specificity were-3.63,89%and 61%,respectively.? The multivariate logistic regression analysis of left ventricular and left atrial strain parameters showed that only BLS can be used as predictors of post-operative EF reduction.The OR(95%confidence interval)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,left ventricular I-LS and left atrial 4LAS-LSRe can also predict postoperative left ventricular dysfunction,among which left ventricular BLS was more significant.The left atrial function deformation parameters of patients with mitral regurgitation changed earlier than the left ventricular deformation parameters,but the severity of irreversible myocardial damage was lower than that of the left ventricle.