[Evaluation of myocardial work in patients with mitral valve prolapse and severe regurgitation: predictive value for prolonged postoperative ICU stay].

Objective

To quantitatively evaluate left ventricular myocardial work in patients with mitral valve prolapse with severe regurgitation (MVPSR) and normal left ventricular ejection fraction (LVEF) using pressure-strain loop (PSL) technology, and explore its predictive value for the duration of patients' postoperative stay in the intensive care unit (ICU).

Methods

MVPSR patients with normal LVEF who were treated at Fuwai Huazhong Cardiovascular Hospital from May 2023 to June 2025 were included as the MVPSR group. All patients underwent cardiac valve repair or valve replacement surgery and underwent echocardiography before surgery. Subjects who were matched for gender, age, body mass index as well as comorbidities, and underwent echocardiography during the same period, and were excluded from MVPSR were selected as the non-MVPSR group. Left ventricular global longitudinal strain, longitudinal strain peak time dispersion and global work index, global work efficiency (GWE), global constructive work, global wasted work, as well as the longitudinal strain and work parameters for each segment (basal, mid, and apical segments) were assessed using PSL technology. The duration of ICU stay for patients in the MVPSR group after mitral valve surgery were recorded, and a prolonged ICU stay was defined as a duration >48 hours. The differences in left ventricular myocardial work parameters between the two groups were compared, and the impact of GWE on the duration of patients' early postoperative ICU stay was analyzed using a multifactor linear regression model. Receiver operating characteristic curve analysis was applied to evaluate the predictive performance of GWE for prolonged ICU stay.

Results

There were 80 patients in the MVPSR group, aged (58.9±12.3) years, including 61 males. There were 58 patients in the non-MVPSR group, including 31 healthy subjects, aged (54.8±15.3) years, including 36 males. The postoperative ICU stay time in the MVPSR group was (37.0±16.8) hours. Compared with the non-MVPSR group, the MVPSR group had lower global work index, GWE and global constructive work, and higher global wasted work; the work efficiency and constructive work in the basal, intermediate and apical segments were all lower, and the wasted work was higher; the longitudinal strain and work index in the basal segment were both lower (all P<0.05). The results of the multi-factor linear regression model analysis showed that GWE was an independent influencing factor for postoperative ICU stay duration in MVPSR patients (β=-2.89, 95%CI -5.43--0.34, P=0.030). The area under the curve for GWE in predicting prolonged ICU stay time was 0.850 (95%CI 0.729-0.970). The receiver operating characteristic curve showed that the optimal cutoff value for GWE for predicting prolonged ICU stay was 92.5%, namely GWE≤92.5% predicting prolonged stay in ICU, with a sensitivity of 76.2% and a specificity of 82.4%.

Conclusions

Patients with MVPSR and normal LVEF exhibit varying degrees of alterations in global and segmental left ventricular myocardial work parameters. GWE is negatively correlated with postoperative ICU length of stay and has certain predictive value for prolonged ICU stay after surgery.