BACKGROUND AND AIM OF THE STUDY: Despite the effect of mitral valve repair in left ventricular (LV) function having been extensively studied, investigations of left atrial (LA) performance indices are minimal. This prospective study was undertaken to analyze LA volumes, function and work in patients with chronic mitral valve regurgitation (MR) who underwent mitral valve repair; the analyses were conducted both before and six months after surgery. METHODS: Twenty patients (15 males, five females; mean age 51.4 +/- 12.5 years) with severe MR (grade IV) due to floppy mitral valve/mitral valve prolapse (FMV/MVP; anterior, posterior or both) underwent mitral valve repair. LA volumes, maximal at mitral valve opening (LAmax); minimal at valve closure (LAmin); and at onset of atrial systole (P-wave on ECG, LAP); and transmitral Doppler A-wave velocity were measured before and six months after surgery. LA stroke volume (LASV) = LAP - LAmin; LA ejection fraction (LAEF) = LASV/LAP; LA kinetic energy (LAKE) = 1/2 x LASV x 1.06 (specific gravity of blood) x A2 (dyne x cm x 10(3)); LA and LV dimensions and functions were assessed at the same time. RESULTS: NYHA functional class was improved postoperatively by at least one grade. LV systolic and diastolic dimensions were reduced significantly in all patients (p <0.001). LA volumes (LAmax, LAmin and LAP) were decreased significantly in all patients (p <0.001); LASV remained unchanged. LAEF and LAKE were increased significantly (both p <0.001). The A-wave was also increased (p <0.001). CONCLUSION: Increased LA work (LAKE) after mitral valve repair, despite a decrease in LA volumes, suggests that LA muscle dysfunction was present before surgery. LA involvement may precede LV involvement. The determination of LA performance and work will help to optimize the timing of surgery in patients with FMV/MVP and MVR.
BACKGROUND AND AIM OF THE STUDY: Despite the effect of mitral valve repair in left ventricular (LV) function having been extensively studied, investigations of left atrial (LA) performance indices are minimal. This prospective study was undertaken to analyze LA volumes, function and work in patients with chronic mitral valve regurgitation (MR) who underwent mitral valve repair; the analyses were conducted both before and six months after surgery. METHODS: Twenty patients (15 males, five females; mean age 51.4 +/- 12.5 years) with severe MR (grade IV) due to floppy mitral valve/mitral valve prolapse (FMV/MVP; anterior, posterior or both) underwent mitral valve repair. LA volumes, maximal at mitral valve opening (LAmax); minimal at valve closure (LAmin); and at onset of atrial systole (P-wave on ECG, LAP); and transmitral Doppler A-wave velocity were measured before and six months after surgery. LA stroke volume (LASV) = LAP - LAmin; LA ejection fraction (LAEF) = LASV/LAP; LA kinetic energy (LAKE) = 1/2 x LASV x 1.06 (specific gravity of blood) x A2 (dyne x cm x 10(3)); LA and LV dimensions and functions were assessed at the same time. RESULTS: NYHA functional class was improved postoperatively by at least one grade. LV systolic and diastolic dimensions were reduced significantly in all patients (p <0.001). LA volumes (LAmax, LAmin and LAP) were decreased significantly in all patients (p <0.001); LASV remained unchanged. LAEF and LAKE were increased significantly (both p <0.001). The A-wave was also increased (p <0.001). CONCLUSION: Increased LA work (LAKE) after mitral valve repair, despite a decrease in LA volumes, suggests that LA muscle dysfunction was present before surgery. LA involvement may precede LV involvement. The determination of LA performance and work will help to optimize the timing of surgery in patients with FMV/MVP and MVR.
Authors: Andreas Goette; Jonathan M Kalman; Luis Aguinaga; Joseph Akar; Jose Angel Cabrera; Shih Ann Chen; Sumeet S Chugh; Domenico Corradi; Andre D'Avila; Dobromir Dobrev; Guilherme Fenelon; Mario Gonzalez; Stephane N Hatem; Robert Helm; Gerhard Hindricks; Siew Yen Ho; Brian Hoit; Jose Jalife; Young-Hoon Kim; Gregory Y H Lip; Chang-Sheng Ma; Gregory M Marcus; Katherine Murray; Akihiko Nogami; Prashanthan Sanders; William Uribe; David R Van Wagoner; Stanley Nattel Journal: Heart Rhythm Date: 2016-06-10 Impact factor: 6.343
Authors: Benjamin Essayagh; Giovanni Benfari; Clémence Antoine; Joseph Maalouf; Sorin Pislaru; Prabin Thapa; Hector I Michelena; Maurice Enriquez-Sarano Journal: J Am Heart Assoc Date: 2022-04-26 Impact factor: 6.106
Authors: Andreas Goette; Jonathan M Kalman; Luis Aguinaga; Joseph Akar; Jose Angel Cabrera; Shih Ann Chen; Sumeet S Chugh; Domenico Corradi; Andre D'Avila; Dobromir Dobrev; Guilherme Fenelon; Mario Gonzalez; Stephane N Hatem; Robert Helm; Gerhard Hindricks; Siew Yen Ho; Brian Hoit; Jose Jalife; Young-Hoon Kim; Gregory Y H Lip; Chang-Sheng Ma; Gregory M Marcus; Katherine Murray; Akihiko Nogami; Prashanthan Sanders; William Uribe; David R Van Wagoner; Stanley Nattel Journal: J Arrhythm Date: 2016-07-11