A1 Refereed original research article in a scientific journal

Prognostic impact of left ventricular myocardial work in patients undergoing surgery for primary mitral regurgitation




AuthorsNabeta, Takeru; Peters, Ferande; Wu, Hoi W.; Chua, Aileen Paula; Palmen, Meindert; Tomšič, Anton; Marsan, Nina Ajmone; Bax, Jeroen J.; van der Bijl, Pieter

PublisherSpringer Nature

Publication year2025

JournalInternational Journal of Cardiovascular Imaging

Journal name in sourceThe International Journal of Cardiovascular Imaging

Volume41

First page 991

Last page1000

ISSN1569-5794

eISSN1875-8312

DOIhttps://doi.org/10.1007/s10554-025-03386-x

Web address https://doi.org/10.1007/s10554-025-03386-x

Self-archived copy’s web addresshttps://research.utu.fi/converis/portal/detail/Publication/491926290


Abstract

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.


Last updated on 2025-23-05 at 15:35