Visual Abstract - Pre-Operative Left Ventricular Torsion, QRS Width/CRT, and Post-Mitral Surgery Outcomes in Patients With Nonischemic, Chronic, Severe Secondary Mitral Regurgitation: 10.1016/j.jacbts.2016.04.006

• Determining which patients with NICSMR will benefit from MS is a clinical dilemma.

• LV torsion (which is a shear strain, not volume strain such as ejection fraction and originates in LV myocardial architectures) may reveal the myopathic conditions and reflect intra-LV electrical conduction.

• The LV torsional profile predicted post-MS outcomes in NICSMR patients with a narrow QRS but not in those with a wide QRS.

• The findings may help to resolve the clinical dilemma and identify appropriate candidates for mitral surgery (and other resources) in patients with NICSMR.