Alexandre Altes, Valentine Pécriaux, Paulin Hanvi, Vincent Hanet, Inès Belhakia, Noémie Selin, David Vancraeynest, Agnès Pasquet, François Delelis, Manuel Toledano, Valentina Silvestri, Bernhard L Gerber, Sylvestre Maréchaux
{"title":"术前心脏磁共振和超声心动图与原发性二尖瓣反流术后左心室功能障碍的关系。","authors":"Alexandre Altes, Valentine Pécriaux, Paulin Hanvi, Vincent Hanet, Inès Belhakia, Noémie Selin, David Vancraeynest, Agnès Pasquet, François Delelis, Manuel Toledano, Valentina Silvestri, Bernhard L Gerber, Sylvestre Maréchaux","doi":"10.1016/j.echo.2025.09.015","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>We evaluated the relationship between preoperative left ventricular (LV) structural and functional characteristics assessed by echocardiography (Echo) and cardiac magnetic resonance (CMR), and the risk of post-operative left ventricular (LV) dysfunction in patients with primary mitral regurgitation (MR) undergoing mitral valve (MV) repair surgery.</p><p><strong>Methods: </strong>We retrospectively studied 223 patients (median age 60 years, 21% women) with chronic primary MR who underwent preoperative Echo and CMR before MV repair surgery. The primary endpoint was post-operative LV dysfunction, defined as LV ejection fraction (EF) < 50% on follow-up Echo.</p><p><strong>Results: </strong>Post-operative LV dysfunction occurred in 41 patients (18%) after a median follow-up of 8.7 [IQR: 6.7-12.5] months. These patients had higher absolute and indexed (ind) LV end-systolic diameters (ESD) and volumes (ESV) (all p≤0.009), lower CMR-LVEF (p=0.003), and a trend towards lower Echo-LVEF (p=0.072). Individually, Echo and CMR parameters showed modest discriminative ability (areas under the curve from 0.59 [0.49-0.68] for Echo-LVEF - to 0.70 [0.61-0.78] for Echo-indLVESD). Strain imaging, whether assessed by Echo or CMR, did not improve risk stratification. Echo-indLVESD and CMR-LVEF were the most contributive LV characteristics. A two-step approach based on Echo-indLVESD < or ≥ 18 mm/m<sup>2</sup>, followed by CMR-LVEF > or ≤ 56% in patients with Echo-indLVESD ≥ 18 mm/m<sup>2</sup>, identified three subgroups with distinct rates of post-operative LV dysfunction (9%, 20% and 41%, respectively).</p><p><strong>Conclusion: </strong>In patients with primary MR undergoing MV surgery, preoperative LV characteristics assessed by Echo and CMR showed only moderate ability to identify those at higher risk of post-operative LV dysfunction. A stepwise approach using Echo-indLVESD followed by CMR-LVEF may help identify subgroups at differing risk levels. These exploratory findings require confirmation in larger prospective studies.</p>","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":" ","pages":""},"PeriodicalIF":6.0000,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Association of Preoperative Cardiac Magnetic Resonance and Echocardiography with Post-Operative Left Ventricular Dysfunction in Primary Mitral Regurgitation.\",\"authors\":\"Alexandre Altes, Valentine Pécriaux, Paulin Hanvi, Vincent Hanet, Inès Belhakia, Noémie Selin, David Vancraeynest, Agnès Pasquet, François Delelis, Manuel Toledano, Valentina Silvestri, Bernhard L Gerber, Sylvestre Maréchaux\",\"doi\":\"10.1016/j.echo.2025.09.015\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>We evaluated the relationship between preoperative left ventricular (LV) structural and functional characteristics assessed by echocardiography (Echo) and cardiac magnetic resonance (CMR), and the risk of post-operative left ventricular (LV) dysfunction in patients with primary mitral regurgitation (MR) undergoing mitral valve (MV) repair surgery.</p><p><strong>Methods: </strong>We retrospectively studied 223 patients (median age 60 years, 21% women) with chronic primary MR who underwent preoperative Echo and CMR before MV repair surgery. The primary endpoint was post-operative LV dysfunction, defined as LV ejection fraction (EF) < 50% on follow-up Echo.</p><p><strong>Results: </strong>Post-operative LV dysfunction occurred in 41 patients (18%) after a median follow-up of 8.7 [IQR: 6.7-12.5] months. These patients had higher absolute and indexed (ind) LV end-systolic diameters (ESD) and volumes (ESV) (all p≤0.009), lower CMR-LVEF (p=0.003), and a trend towards lower Echo-LVEF (p=0.072). Individually, Echo and CMR parameters showed modest discriminative ability (areas under the curve from 0.59 [0.49-0.68] for Echo-LVEF - to 0.70 [0.61-0.78] for Echo-indLVESD). Strain imaging, whether assessed by Echo or CMR, did not improve risk stratification. Echo-indLVESD and CMR-LVEF were the most contributive LV characteristics. A two-step approach based on Echo-indLVESD < or ≥ 18 mm/m<sup>2</sup>, followed by CMR-LVEF > or ≤ 56% in patients with Echo-indLVESD ≥ 18 mm/m<sup>2</sup>, identified three subgroups with distinct rates of post-operative LV dysfunction (9%, 20% and 41%, respectively).</p><p><strong>Conclusion: </strong>In patients with primary MR undergoing MV surgery, preoperative LV characteristics assessed by Echo and CMR showed only moderate ability to identify those at higher risk of post-operative LV dysfunction. A stepwise approach using Echo-indLVESD followed by CMR-LVEF may help identify subgroups at differing risk levels. These exploratory findings require confirmation in larger prospective studies.</p>\",\"PeriodicalId\":50011,\"journal\":{\"name\":\"Journal of the American Society of Echocardiography\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":6.0000,\"publicationDate\":\"2025-09-29\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the American Society of Echocardiography\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.echo.2025.09.015\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American Society of Echocardiography","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.echo.2025.09.015","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Association of Preoperative Cardiac Magnetic Resonance and Echocardiography with Post-Operative Left Ventricular Dysfunction in Primary Mitral Regurgitation.
Background: We evaluated the relationship between preoperative left ventricular (LV) structural and functional characteristics assessed by echocardiography (Echo) and cardiac magnetic resonance (CMR), and the risk of post-operative left ventricular (LV) dysfunction in patients with primary mitral regurgitation (MR) undergoing mitral valve (MV) repair surgery.
Methods: We retrospectively studied 223 patients (median age 60 years, 21% women) with chronic primary MR who underwent preoperative Echo and CMR before MV repair surgery. The primary endpoint was post-operative LV dysfunction, defined as LV ejection fraction (EF) < 50% on follow-up Echo.
Results: Post-operative LV dysfunction occurred in 41 patients (18%) after a median follow-up of 8.7 [IQR: 6.7-12.5] months. These patients had higher absolute and indexed (ind) LV end-systolic diameters (ESD) and volumes (ESV) (all p≤0.009), lower CMR-LVEF (p=0.003), and a trend towards lower Echo-LVEF (p=0.072). Individually, Echo and CMR parameters showed modest discriminative ability (areas under the curve from 0.59 [0.49-0.68] for Echo-LVEF - to 0.70 [0.61-0.78] for Echo-indLVESD). Strain imaging, whether assessed by Echo or CMR, did not improve risk stratification. Echo-indLVESD and CMR-LVEF were the most contributive LV characteristics. A two-step approach based on Echo-indLVESD < or ≥ 18 mm/m2, followed by CMR-LVEF > or ≤ 56% in patients with Echo-indLVESD ≥ 18 mm/m2, identified three subgroups with distinct rates of post-operative LV dysfunction (9%, 20% and 41%, respectively).
Conclusion: In patients with primary MR undergoing MV surgery, preoperative LV characteristics assessed by Echo and CMR showed only moderate ability to identify those at higher risk of post-operative LV dysfunction. A stepwise approach using Echo-indLVESD followed by CMR-LVEF may help identify subgroups at differing risk levels. These exploratory findings require confirmation in larger prospective studies.
期刊介绍：
The Journal of the American Society of Echocardiography(JASE) brings physicians and sonographers peer-reviewed original investigations and state-of-the-art review articles that cover conventional clinical applications of cardiovascular ultrasound, as well as newer techniques with emerging clinical applications. These include three-dimensional echocardiography, strain and strain rate methods for evaluating cardiac mechanics and interventional applications.
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