PREDICTION OF LEFT VENTRICULAR SYSTOLIC AND DIASTOLIC FUNCTIONS SIX MONTHS FOLLOWING MITRAL VALVE REPLACEMENT USING NEW ECHO DOPPLER INDICES | ||||
| Zagazig University Medical Journal | ||||
| Article 5, Volume 24, Issue 1, January 2018, Page 34-43 PDF (445.53 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/zumj.2018.12998 | ||||
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| Authors | ||||
| Moataz Abdelmonem Elkot; Ahmed Shafie Ammar; Islam Abd-ELmoneem ELsherbiny; Khaled Hassan Abdelbary | ||||
| Abstract | ||||
| ABSTRACT Background: The development of left ventricular dysfunction is a major concern in the management of patients with severe mitral regurgitation. In the initial stages, contractility impairment may be ‘‘invisible’’ by the traditional methods to assess the ventricular function, because of different loading conditions. This fact can mask the presence of LV dysfunction. Sometimes, LV dysfunction may be ‘‘unmasked’’ only by change in loading conditions after surgical correction, leading to the development of overt LV dysfunction and congestive heart failure. The identification of contractile dysfunction at an early stage and surgical correction may avoid the development of irreversible postoperative LV dysfunction. Objectives: To test the efficacy of new echocardiographic indices in predicting post operative left ventricular dysfunction and compare the diagnostic accuracy of these indices . Subjects and Methods: The study included 41 patients with severe isolated Mitral regurgitation with ejection fraction > 50 %, prepared for mitral valve replacement. Patients were examined clinically and by Echocardiography pre and post operative. The following Echo Doppler modalities were done to the patients pre operative and 6 months post operative: Global longitudinal strain(GLS) , Modified Simpson ,dp/dt , IVRT/T(E-è) the early diastolic Driving Force , early diastolic and early systolic mitral annular velocity by tissue Doppler. Patients were then classified into Four sub groups according to post operative systolic and diastolic function, Group 1A were patients with normal post operative systolic function , Group 1B were patients with post operative systolic dysfunction , Group 2A were patients with normal post operative diastolic function , Group 2B were patients with post operative diastolic dysfunction. Results: For prediction of systolic dysfunction ROC curve analysis showed high significant value of pre operative GLS in predicting post operative systolic dysfunction with cutoff value= -18.5 , high significant value of pre operative modified Simpson in predicting post operative systolic dysfunction with cutoff value=54.5, and significant value of pre operative dp/dt in predicting post operative systolic dysfunction with cutoff value=1166 mmHg/sec. The multivariate analysis showed that the independent variables for predicting post operative systolic dysfunction were pre operative GLS and dp/dt. For prediction of diastolic dysfunction ROC curve analysis showed high significant value of pre operative GLS in predicting post operative diastolic dysfunction with cutoff value=-18.5, and significant value of pre operative IVRT/T(E-e\) in predicting post operative diastolic dysfunction with cutoff value=2.95. Multivariate analysis showed that the independent variables for predicting post operative diastolic dysfunction were preoperative GLS & preoperative IVRT/T (E-e\). Conclusions: We can depend on pre operative Global Longitudinal Strain (GLS) and dp/dt in predicting post operative systolic dysfunction with cut off value=-18.5 and 1166 mmHg/sec respectively. We can also depend on preoperative GLS and IVRT/T (E-e\) in predicting post operative diastolic dysfunction with cutoff value=-18.5 and 2.95 respectively | ||||
| Keywords | ||||
| Keywords: Left Ventricular Dysfunction •Mitral Valve Replacment •Predictors | ||||
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