PREDICTION OF LEFT VENTRICULAR SYSTOLIC AND DIASTOLIC FUNCTIONS SIX MONTHS FOLLOWING MITRAL VALVE REPLACEMENT USING NEW ECHO DOPPLER INDICES

Abstract

ABSTRACT
Background: The development of left ventricular dysfunction is a major concern in the management of patients with
severe mitral regurgitation. In the initial stages, contractility impairment may be ‘‘invisible’’ by the traditional methods
to assess the ventricular function, because of different loading conditions. This fact can mask the presence of LV
dysfunction. Sometimes, LV dysfunction may be ‘‘unmasked’’ only by change in loading conditions after surgical
correction, leading to the development of overt LV dysfunction and congestive heart failure. The identification of
contractile dysfunction at an early stage and surgical correction may avoid the development of irreversible postoperative
LV dysfunction.
Objectives: To test the efficacy of new echocardiographic indices in predicting post operative left ventricular
dysfunction and compare the diagnostic accuracy of these indices .
Subjects and Methods: The study included 41 patients with severe isolated Mitral regurgitation with ejection fraction
> 50 %, prepared for mitral valve replacement. Patients were examined clinically and by Echocardiography pre and post
operative. The following Echo Doppler modalities were done to the patients pre operative and 6 months post operative:
Global longitudinal strain(GLS) , Modified Simpson ,dp/dt , IVRT/T(E-è) the early diastolic Driving Force , early
diastolic and early systolic mitral annular velocity by tissue Doppler. Patients were then classified into Four sub groups
according to post operative systolic and diastolic function, Group 1A were patients with normal post operative systolic
function , Group 1B were patients with post operative systolic dysfunction , Group 2A were patients with normal post
operative diastolic function , Group 2B were patients with post operative diastolic dysfunction.
Results: For prediction of systolic dysfunction ROC curve analysis showed high significant value of pre operative GLS
in predicting post operative systolic dysfunction with cutoff value= -18.5 , high significant value of pre operative
modified Simpson in predicting post operative systolic dysfunction with cutoff value=54.5, and significant value of pre
operative dp/dt in predicting post operative systolic dysfunction with cutoff value=1166 mmHg/sec. The multivariate
analysis showed that the independent variables for predicting post operative systolic dysfunction were pre operative
GLS and dp/dt.
For prediction of diastolic dysfunction ROC curve analysis showed high significant value of pre operative GLS in
predicting post operative diastolic dysfunction with cutoff value=-18.5, and significant value of pre operative
IVRT/T(E-e\) in predicting post operative diastolic dysfunction with cutoff value=2.95. Multivariate analysis showed
that the independent variables for predicting post operative diastolic dysfunction were preoperative GLS & preoperative
IVRT/T (E-e\).
Conclusions: We can depend on pre operative Global Longitudinal Strain (GLS) and dp/dt in predicting post operative
systolic dysfunction with cut off value=-18.5 and 1166 mmHg/sec respectively. We can also depend on preoperative
GLS and IVRT/T (E-e\) in predicting post operative diastolic dysfunction with cutoff value=-18.5 and 2.95
respectively.
Keywords: Left Ventricular Dysfunction •Mitral Valve Replacment •Predictors.