Impaired LV GLS ups mortality risk in patients with secondary mitral regurgitation

Impaired left ventricular (LV) global longitudinal strain (GLS), but not LV ejection fraction (EF), is independently associated with a higher risk of all-cause mortality in patients with secondary mitral regurgitation (MR), a study has shown.

Of the 650 patients (mean age, 66±11 years; 68 percent men) with significant secondary MR included, 334 (51 percent) died during a median follow-up of 56 months (interquartile range, 28–106 months).

Mortality rates at 1-, 2- and 5-year follow-up were significantly higher among patients with a more impaired LV GLS (13 percent, 23 percent and 44 percent, respectively) compared with those with more preserved LV systolic function (5 percent, 14 percent and 31 percent, respectively).

Multivariable analysis revealed an association between increased mortality (HR, 1.337, 95 percent confidence interval [CI], 1.038–1.722; p=0.024) and LV GLS <7.0 percent, but not LVEF ≤30 percent (HR, 1.055, 95 percent CI, 0.794–1.403; p=0.711).

“LV GLS may therefore be useful in the risk stratification of patients with secondary MR,” the investigators said.

This study aimed at showing the prognostic value of LV GLS over LVEF in patients with secondary MR. The participants were subdivided based on their LV GLS value at which the HR for all-cause mortality was >1 using a spline curve analysis (LV GLS <7.0 percent, impaired LV systolic function vs LV LV GLS ≥7.0 percent, preserved LV systolic function.

“LV systolic function may be overestimated in patients with secondary MR when using LVEF,” the investigators noted. “LV GLS is a less load-dependent measure of LV function.”