Speckle-Tracking Echocardiography Predicts Adverse Left Ventricular Remodeling After Valve Replacement in Rheumatic Mitral Stenosis

Abstract

Background

Rheumatic mitral stenosis(RMS) may leads to left ventricular remodeling (LVR), which can persist even after valve surgery. Identifying markers for early structure and function in patients with rheumatic heart disease who are at risk for adverse LVR after surgery can help determine the optimal timing of intervention. This study aimed to investigate whether preoperative parameters of global left ventricular long-axis strain (LVGLS) and mechanical discretization (MD) could predict postoperative adverse LVR.

Methods

A total of 109 adult patients with RMS and 50 healthy controls were enrolled in this study. Baseline clinical features, conventional echocardiography results, LVGLS, and MD were compared between the two groups. Pre- and post-surgery echocardiography measurements were collected, and adverse LVR was defined as a>15% increase in left ventricular end-diastolic volume or >10% decrease in left ventricular ejection fraction. Binary regression analysis was used to determine independent predictors of poor left ventricular remodeling.

Results

The variables associated with adverse LVR in this study were LVGLS (P<0.001, odds ratio: 1.996, 95% CI: 1.394–2.856) and MD (P=0.011, odds ratio: 1.031, 95% CI: 1.007–1.055). The poorly reconstructed group had lower absolute values of LVGLS and higher MD than the healthy control group and the non-poorly reconstructed group. A LVGLS cutoff of −15.0% was the best predictor for patients with poorly reconstructed LVR (sensitivity: 75.7%; specificity: 100.0%; AUC: 0.93), and a MD cutoff of 63.8ms was the best predictor (sensitivity: 63.8%; specificity: 98.6%; AUC: 0.88).

Conclusion

Speckle tracking echocardiography has potential value for predicting the progression of adverse LVR and for identifying non-responders among patients with RMS undergoing surgery.

Keywords:

• rheumatic mitral stenosis
• left ventricular remodeling
• left ventricular global longitudinal strain
• mechanical dispersion
• speckle tracking echocardiography

Data Sharing Statement

Data applied in the course of this study are available from the corresponding author on reasonable request.

Ethics Approval and Consent to Participate

The present study was a retrospective case–control study. It met the requirements laid out in the Declaration of Helsinki. Approval for this study was provided by the Ethics Committee of The First Affiliated Hospital of Guangxi Medical University (No.2022-KY-E-132), waiving the right to sign the informed consent form; It relates only to anonymous imaging data set; No individual patient data or human tissue samples were collected.

Acknowledgments

X.Z. and J.Z are co-first authors.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This study was supported in part by Natural Science Foundation of Guangxi Zhuang Autonomous Region (Grant No. 2017GXNSFAA198246); Key project of Guangxi Science and Technology Program (No. 2023GXNSFDA026010); Key R&D projects in Hubei Province (Grant No.2022BCE004).