Among asymptomatic patients with chronic, severe primary MR, can serial global longitudinal strain measurements assist with determining timing for repeat surveillance TEEs and/or facilitate timing for MVR?

The first issue when discussing asymptomatic, severe valve disease is clarifying symptom status. Hemodynamic stress echocardiography or catheterization may unmask symptoms or elevated pulmonary artery pressures at an age-appropriate workload; abnormalities of functional capacity or pulmonary pressure may be underreported by sedentary patients and have been repeatedly associated with worse outcome after valve surgery.

In patients who are truly asymptomatic with good functional capacity, the ideal timing for mitral valve surgery for mitral regurgitation (MR) would be the moment when LV function just begins to deteriorate, before a drop in LVEF or symptoms appear. Whether biomarkers or global longitudinal strain (GLS) are helpful to identify t...