http://imaging.onlinejacc.org/content/11/9/1235
Myocardial Strain in Prediction of Outcomes After Surgery for Severe Mitral Regurgitation
Conclusions GLS appears to be a better predictor of cardiac events all-cause death than conventional parameters. Measuring preoperative GLS is helpful to predict post-operative outcome and determine optimal timing for surgery in patients with severe primary MR.
Exercise Testing Mitral regurgitation is dynamic, and its severity is altered by afterload, preload, chamber size, left atrial pressure, and LV contractility.In asymptomatic patients with substantial MR, serial exercise testing provides an objective way to detect or exclude symptoms as well as to evaluate functional capacity .
Delaying MV surgery by 1 year in asymptomatic patients with severe DMR but with good exercise capacity is not associated with worse outcomes.
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https://jamanetwork.com/journals/jamacardiology/article-abstract/2759799
Appropriate timing for surgery in DMR is challenging and requires more than guidelines; it also requiresexperienced clinical judgmentand thoughtful discussionswith patients for shared decision-making