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Abstract In patients with asymptomatic primary chronic severe mitral regurgiation (MR), the increased preload without an increase in afterload which may even decrease will result in a higher or near normal Ejection fraction (EF). However, left ventricular (LV) systolic dysfunction may be 2unmasked3 only after surgical correction despite the apparently normal preoperative EF. We assessed the different LV systolic function indices by transthoracic echocardiography (TTE) in these patients that might predict early LV systolic dysfunction. The study included 70 patients with asymptomatic primary chronic severe mitral regurgitation; 35 had rheumatic etiology and 35 patients diagnosed as mitral valve prolapse. In addition, 35 age and gender matched healthy subjects were studied and served as control group. All patients were in normal sinus rhythm. All the studied population underwent history taking, clinical examination and ECG. Detailed TTE was done to assess LV function (EF, LV mass, LV mass index(LVMI), LV systolic volume index (LVSVI), relative wall thickness (RWT), Tei index, Tei index by Tissue Doppler (TDI) and LV dP/dt). It has also measured the severity of MR by regurgitant fraction (RF), regurgitant volume (R Vol), regurgitant orifice area (ROA). There was significant difference between the diseased and the control groups regarding the LV systolic function parameters (p=0,001) but theses parameters weren’t found to be significantly correlated with MR severity indices |