A1 Refereed original research article in a scientific journal
Prognostic impact of left ventricular myocardial work in patients undergoing surgery for primary mitral regurgitation
Authors: Nabeta, Takeru; Peters, Ferande; Wu, Hoi W.; Chua, Aileen Paula; Palmen, Meindert; Tomšič, Anton; Marsan, Nina Ajmone; Bax, Jeroen J.; van der Bijl, Pieter
Publisher: Springer Nature
Publication year: 2025
Journal: International Journal of Cardiovascular Imaging
Journal name in source: The International Journal of Cardiovascular Imaging
Volume: 41
First page : 991
Last page: 1000
ISSN: 1569-5794
eISSN: 1875-8312
DOI: https://doi.org/10.1007/s10554-025-03386-x
Web address : https://doi.org/10.1007/s10554-025-03386-x
Self-archived copy’s web address: https://research.utu.fi/converis/portal/detail/Publication/491926290
Purpose
Echocardiography-based, left ventricular myocardial work (LVMW) can assess LV function by incorporating LV afterload. This study aims to evaluate the prognostic value of LVMW indices in patients with primary mitral regurgitation (MR) undergoing mitral valve surgery.
Methods and results
A total of 306 patients (mean age 63 ± 12 years, 68% male) with severe, primary MR who underwent surgery, were included. All patients underwent transthoracic echocardiography and LVMW indices were assessed with commercially available ultrasound equipment before surgery. The mean LV global work index (LVGWI) was 1979 ± 537 mmHg% and 130 (42%) patients had impaired LVGWI (≤ 1900 mmHg%). During a median follow-up of 5.0 years (interquartile range, 2.5-8.9), 27 (8.8%) patients died after mitral valve surgery. Patients with impaired LVGWI or LV global longitudinal strain (LVGLS) (≤ 20%) had lower survival rates compared to the group with preserved (p < 0.01 and p = 0.02, respectively). While the likelihood ratio test suggests that LVGWI ≤ 1900 mmHg% provides additional prognostic information beyond the model including LVGLS (p < 0.05) for all-cause mortality, no significant improvement was observed in area under the curve, the C-index, or net-reclassification index.
Conclusions
In patients with severe, primary MR who underwent surgery, impaired pre-operative LVGWI was associated with a higher mortality risk, and may have incremental value beyond LVGLS, but requires further study for validation.
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Funding information in the publication:
The Department of Cardiology of Leiden University Medical Center received research grants from Abbott Vascular, Bayer, Biotronik, Bioventrix, Boston Scientific, Edwards Lifesciences, GE Healthcare, Medtronic and Novartis. Nina Ajmone Marsan received speaker fees from Abbott Vascular and GE Healthcare. Jeroen J. Bax received speaker fees from Abbott Vascular, Edwards Lifesciences, and Omron. The remaining authors have nothing to disclose.