Mitral Regurgitation Clinical Trial
Official title:
Assessment of Subclinical Left Atrial and Left Ventricular Dysfunction by Speckle Tracking Echocardiography in Severe Asymptomatic Rheumatic Mitral Regurgitation and Its Role in Predicting Outcome After Valve Replacement Compared to Guideline Parameters
The study aims to analyze the role of left ventricular and left atrial functional parameters by speckle tracking echocardiography in predicting outcome after mitral valve replacement and targeting for early intervention compared to guideline parameters.
Without surgical treatment, the 10-year morbidity and mortality for patients with severe
mitral regurgitation can be as high as 90%.
In contrast, with successful surgical correction of mitral regurgitation before the
appearance of symptoms, patients may have life expectancies similar to that of the general
population.
According to European recommendations, mitral valve replacement must be proposed to
symptomatic patients and to patients with significant left ventricular remodeling as a
consequence of the severity of mitral regurgitation.
A significant decline in left ventricular function is defined, in these recommendations,
echocardiographically as an left ventricular ejection fraction < 60% or an left ventricular
end-systolic diameter > 45 mm.
Preoperative left ventricular systolic function and left ventricular end systolic diameter
are important postoperative prognostic factors.
The early detection of left ventricular systolic dysfunction remains a challenge. Mitral
regurgitation causes low left ventricular afterload, and the ejection fraction thus remains
normal or supernormal until the disease reaches an advanced stage.
Some authors have suggested the additive value of deformation indices as more sensitive than
the ejection fraction to detect subclinical left ventricular systolic dysfunction Speckle
tracking echocardiography has been well validated as a quantitative assessment tool for left
ventricular function, and more recently this technique has been described for assessment of
regional and global left atrial function
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