Prognostic value of left ventricular recoil in primary chronic mitral regurgitation.

Purpose: To evaluate the prognostic value of abnormalities of left atrial (LA) and/or ventricular (LV) mechanics as predictors of cardiovascular events during follow-up in asymptomatic patients with chronic primary mitral regurgitation (MR). Methods: 68 patients (mean age 57+17 years) with mitral valve prolapse, MR and normal LV ejection fraction were prospectively enrolled. Patients were divided into three groups according to the severity of MR: mild (n=24), moderate (n=21) and severe (n=23). Two-dimensional echocardiographic images were acquired for speckle tracking analysis. At the end of follow-up, patients were subdivided into two group according to the occurrence of events (death, dyspnea/palpitations and MV surgery). Results: Compared to patients with mild MR, those with moderateMRshowed increased LV mass index (p, 0.001), E/E’ (p=0.01), PAPs (p=0.007), basal rotation (p=0.04), twist (p=0.004), reduced longitudinal LV strain (p=0.04) and LA strain (p=0.005); furthermore LV mass index (p,0.001), LV volumes (EDV p,0.001, ESV p=0.007), sphericity index (p=0.003), E/A (p=0.005), E/E’ (p=0.003), LA volume (p=0.002) and PAPs (p=0.01) were higher in pts with severe than in those with moderate MR, whereas LA strain (p,Abstract P1276 Figure. Diastolic Sr in prediction of symptoms 0.001)and LV recoil (p,0.001) were lower in pts with severe than in those with moderate MR. After a mean follow-up of 23.8 months+17.5, 39 (57%) patients remained asymptomatic whereas 29 (42%) developed events (17=MV surgery, 9=dyspnea/palpitations, 5=deaths). Compared to asymptomatic patients, those with events showed: higher LV sphericity index (0.65+0.06 vs 0.60+0.08, p=0.028) and LV global circumferential strain (-23.2+4.8 vs -20.7+4.7, p=0.043) and decreased: LA strain (25.5+8.1% vs 31.9+7.9%, p=0.003), LV global longitudinal strain (-19.1+4.7 vs -21.1+2.5, p=0.030), LVrecoil (-69.7+34.6 vs -86.8+23.2, p=0.024).Onunivariate Coxregression analysis, mitral E/A ratio (HR=2.4, CI 1.2-4.8, p=0.010), LA volume (HR=1.02, CI 1.00-1.05, p=0.025), LA strain (HR=0.92, CI 0.87-0.97, p=0.003) and LV recoil (HR=1.02, C.I. 1.00-1.03, p=0.012) were associated with increased risk of events. On multivariate regression analysis, only LV recoil was independent predictor of events (HR=1.03, CI 1.00-1.04, p=0.024). The ROC analysis showed that a cut-off recoil=-77.58/sec had the higher sensitivity and specificity to identify patients at major risk (AUC=0.73; Sensitivity 73%, Specificity 72%). Conclusions: Impaired LA and LV mechanics are associated with the occurrence of events in asymptomatic patients with MR, however LV recoil is the only independent predictor of a worse prognosis.