JACC Cardiovasc Imaging. 2026;19(5):588-599.
Integrated Atrial and Ventricular Strain Assessment in Patients With Severe Degenerative Mitral Regurgitation Undergoing Surgery.
제1저자 오진경, 곽순구 · 교신저자 이승표, 김대희
소속 (7)
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea.
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Seoul, Republic of Korea.
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address: sproll1@snu.ac.kr.
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. Electronic address: daehee74@amc.seoul.kr.
Abstract
BACKGROUND Current guidelines for degenerative mitral regurgitation (MR) emphasize left ventricular (LV) dysfunction. However, subclinical alterations in left atrial (LA) or LV strain may manifest earlier in severe MR.
OBJECTIVES This study sought to determine whether combined LA and LV strain measurements improve long-term mortality prediction in severe degenerative MR, especially in asymptomatic individuals.
METHODS This retrospective derivation cohort included 1,314 patients (mean age: 55 ± 13 years; 35% women) who underwent valve repair or replacement for severe MR. Preoperative peak atrial longitudinal strain (PALS) and LV-global longitudinal strain (GLS) were measured. Patients were categorized into 4 groups by using spline-derived thresholds (PALS: <21.4%; LV-GLS: >-20.5%). The primary outcome was all-cause mortality (median follow-up, 8.4 years). External validation included 605 independent patients.
RESULTS Impaired PALS (adjusted HR [aHR]: 2.11; P < 0.001) and impaired LV-GLS (aHR: 1.66; P = 0.008) were independently associated with high mortality. The group with both impaired PALS and LV-GLS demonstrated the worst outcome (aHR: 2.50; P < 0.001). In asymptomatic patients (n = 900), the combined use of both strain parameters outperformed traditional LV dysfunction criteria (LV ejection fraction ≤60% or LV end-systolic dimension ≥40 mm), thereby significantly improving net reclassification (net reclassification index = 0.436; P < 0.001) and discrimination (integrated discrimination improvement = 0.024; P = 0.003). Subgroup analyses demonstrated that the prognostic contribution of each strain parameter varied by the functional status of the other chamber. External validation confirmed these associations.
CONCLUSIONS Concomitant impairment of both PALS and LV-GLS identified patients at the highest mortality risk. These findings support an integrated atrial-ventricular strain assessment to improve prognostic stratification, particularly in asymptomatic patients with severe degenerative MR who are undergoing MV surgery.
Copyright © 2026 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Keywords
mitral regurgitationprognosisstrain echocardiographysurgery
Conflict of interest statement
Funding Support and Author Disclosures This research has received support from a grant from the Korea Health Technology R and D Project through the Korea Health Industry Development Institute, funded by the Ministry of Health and Welfare, Republic of Korea (grant number HI22C0154). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
그 밖의 정보
- 출판 형태
- Journal Article, Validation Study
- 저널
- JACC. Cardiovascular imaging · eISSN 1876-7591
- 전자 출판
- 2026-01-30
- MeSH
- Humans · Female · Middle Aged · Mitral Valve Insufficiency* / physiopathology / surgery / diagnostic imaging / mortality · Global Longitudinal Strain* · Atrial Function, Left* · Retrospective Studies · Predictive Value of Tests · Severity of Illness Index · Ventricular Function, Left* · Male · Risk Factors · Time Factors · Aged · Treatment Outcome · Mitral Valve* / surgery / physiopathology / diagnostic imaging · Ventricular Dysfunction, Left* / physiopathology / diagnostic imaging / mortality · Adult · Heart Valve Prosthesis Implantation* / mortality / adverse effects · Risk Assessment · Asymptomatic Diseases · Reproducibility of Results