PURPOSE Patients with symptomatic heart failure (HF), reduced left ventricular ejection fraction (LVEF), and high-grade functional mitral regurgitation (MR) may benefit from percutaneous edge-to-edge mitral valve repair (PMVR). However, patient selection still remains a central issue. We sought to investigate the potential role of the global longitudinal strain- (GLS-) based left ventricular contractile reserve (LVCR) at dobutamine stress echocardiography (DSE) in this setting. METHODS Thirty-three stable HF patients (MR grade ≥ 3+; median LVEF, 29%; median GLS, -8.3%) who were candidates for PMVR were prospectively enrolled. All patients underwent DSE to assess LVCR (LVEF increase ≥ 5%; GLS increase ≥ 2%; stroke volume [SV] increase ≥ 20% of the measured SV value). RESULTS After DSE, a positive LVCRLVEF was detected in 21 patients (64%), positive LVCRGLS in 12 patients (36%), and positive LVCRSV in 14 patients (42%). LVCRGLS was associated with better symptom relief, MR improvement, and LV reverse remodeling in a short-term follow-up. A significant improvement of GLS during DSE (hazard ratio [HR], 0.549; 95% CI, 0.395-0.765; P < .001), along with history of HF hospitalization (HR, 1.48; 95% CI, 1.119-1.967; P = .006) and beta-blocker therapy (HR, 0.146; 95% CI, 0.046-0.462; P = .001), were independently associated with risk of death/heart transplantation/HF-related hospitalizations. CONCLUSIONS LVCR, assessed by speckle-tracking DSE, is associated with better results after PMVR in the setting of advanced HF. Improvement of longitudinal function emerged, beyond the ejection fraction, as an independent predictor of outcomes and could improve the selection of best candidates for the percutaneous correction of functional MR.

中文翻译：

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全球纵向应变为基础的左心室收缩储备在候选人中对功能性二尖瓣反流的经皮矫正的预后价值：对患者选择的启示。

目的患有症状性心力衰竭（HF），左心室射血分数降低（LVEF）和高级功能性二尖瓣关闭不全（MR）的患者可受益于经皮边缘对边缘二尖瓣修复（PMVR）。但是，患者选择仍然是中心问题。我们试图研究在这种情况下基于多巴酚丁胺应力超声心动图（DSE）的基于全局纵向应变（GLS-）的左心室收缩储备（LVCR）的潜在作用。方法前瞻性纳入了33例稳定的HF患者（MR级≥3+； LVEF中位数为29％； GLS中位数为-8.3％），他们是PMVR的候选者。所有患者均接受DSE评估LVCR（LVEF增加≥5％； GLS增加≥2％；每搏量[SV]增加≥所测SV值的20％）。结果DSE后，在21例患者（64％）中检测到LVCRLVEF阳性，LVCRGLS阳性12例（36％），LVCRSV阳性14例（42％）。LVCRGLS在短期随访中与较好的症状缓解，MR改善和左室反向重塑有关。DSE期间GLS的显着改善（危险比[HR]为0.549; 95％CI为0.395-0.765; P <.001），以及HF住院史（HR为1.48; 95％CI为1.119-1.967; P = .006）和β受体阻滞剂治疗（HR，0.146； 95％CI，0.046-0.462； P = .001）与死亡/心脏移植/ HF相关住院的风险独立相关。结论经斑点追踪DSE评估的LVCR与PMVR后晚期HF患者的更好结果相关。纵向功能的改善超出了射血分数，