The prognostic importance of the right ventricle for patients with mitral regurgitation undergoing surgical treatment: A speckle tracking study

Background: A careful preoperative evaluation of patients with mitral regurgitation (MR) is pivotal to optimize the timing of intervention and clinical outcome. The aim of this study was to evaluate preoperative prognostic parameters, among basic and speckle tracking echocardiography (STE), in patients undergoing MR surgery. Methods: We prospectively enrolled patients with severe MR who underwent preoperative clinical, biohumoral and echocardiographic evaluation, before mitral valve surgery. After surgery, patients were followed to investigate clinical outcome. The primary endpoint was a composite of heart failure hospitalizations and all cause-mortality, the secondary endpoint was to identify the best predictors of postoperative functional capacity assessed by New York heart association (NYHA) class. Results: The final study cohort consisted of 110 patients with a mean age of 64 ± 13 years, 59% male. All strain parameters were reduced, while myocardial work (MW) showed normal values. Median follow-up was 17 (10–29) months. The primary endpoint occurred in 10 patients. Two echocardiographic predictors for the primary endpoint were global peak atrial longitudinal strain (PALS) ≤ 21.5% and free wall right ventricular longitudinal strain (fwRVLS) ≥ −22% with ROC curves. The study population was then divided into 3 groups (Group 1, n = 32: PALS>21.5% and fw-RVLS < −22%, Group 2, n = 46: either global PALS or fwRVLS reduced, Group 3, n = 32: PALS ≤ 21.5% and fwRVLS ≥ −22%). Kaplan–Meier curves showed good risk stratification of the composite endpoint across the three groups. Global wasted work(GWW) was an independent predictor of symptoms persistence (NYHA class > II) at follow-up. Conclusions: STE, particularly with the combination of left atrial and right ventricular strain analysis, can provide additional prognostic value for the preoperative evaluation of patients with MR referred for surgery.