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Aims

This study aimed (1) to evaluate the impact of preprocedural two-dimensional speckle-tracking echocardiography (2D-STE) on long-term outcome after successful percutaneous mitral balloon valvotomy (PMBV) in patients with mitral stenosis (MS) and (2) to determine whether 2D-STE detects underlying diastolic dysfunction as defined by invasive haemodynamic study.

Methods and Results

Sixty-four consecutive MS patients with preserved left ventricular ejection fraction (LVEF ≥50%) and who underwent successfully PMBV were studied. Successful immediate result was defined as post-procedural mitral valve area ≥1.5 cm2 and ≤2/4 mitral regurgitation by catheterization. During a follow-up of 4.2 ± 3.0 years, there were 7 deaths (11%) and 21 late mitral valve reintervention (33%). Univariate predictors of death were global longitudinal strain (GLS), age, LVEF, and pre- and post-procedural pulmonary artery pressures. In the multivariate Cox model, GLS was the strongest predictor of death [hazard ratio (HR) (95% CI), 1.45 (1.07–2.04); P= 0.01]. For the composite endpoint, GLS and post-procedural left atrial pressure (LAP) were univariate predictors of death or reintervention. At multivariable analysis, GLS and post-procedural LAP remained in the final model with strong trend towards significance [GLS HR (95% CI), 1.17 (0.99–1.37); P= 0.056]. There was no correlation between diastolic dysfunction identified at catheterization and standard echocardiographic and 2D-STE indexes, even after adjustments for age, left ventricular mass, effective arterial elastance (afterload), and end-diastolic volume indexes (preload).

Conclusion

GLS is a powerful predictor of long-term outcome after successful PMBV and provides incremental prognostic value over traditional parameters. Echocardiographic diagnosis of concomitant diastolic dysfunction in MS patients remains elusive.

rheumatic heart disease, mitral valve, diastole, mortality
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions, please email: [email protected].
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