BACKGROUND: Left atrial (LA) mechanics in patients with severe mitral regurgitation (MR) remain largely unexplored. The aim of the present evaluation was to assess the effect of severe MR on LA function, its potential relation with conventional surgical indications, and long-term postoperative survival. METHODS: Two-dimensional speckle-tracking strain and volumetric indices of LA reservoir, conduit, and contractile function were assessed in 121 patients with severe MR and 70 controls. Patients were divided according to the presence (n = 46) or absence (n = 75) of one or more guidelines-based criteria for mitral surgery (symptoms, left ventricular ejection fraction ≤ 60%, left ventricular end-systolic diameter ≥ 40 mm, atrial fibrillation, or systolic pulmonary arterial pressure >50 mm Hg). RESULTS: In patients with severe MR compared with controls, significant LA reservoir and contractile dysfunction was observed, which was more pronounced in patients with mitral surgery indication (P < .05 for all strain and volumetric indices). Of all indices of LA function, LA reservoir strain was an independent predictor (odds ratio, 0.88; 95% confidence interval, 0.82-0.94; P < .001) and had the highest accuracy to identify patients with indications for mitral surgery (area under the receiver operating characteristic curve, 0.8; 95% confidence interval, 0.72-0.87). A total of 117 patients underwent mitral valve surgery. Patients with LA reservoir strain ≤24% showed worse survival at a median of 6.4 years (interquartile range, 4.7-8.7 years) after mitral surgery (P = .02), regardless the symptomatic status before surgery. LA reservoir strain, on top of mitral surgery indications, provided incremental predictive value for postoperative survival. CONCLUSIONS: Impaired LA reservoir strain in patients with severe organic MR relates to long-term survival after mitral valve surgery, independently of and incremental to current guidelines-based indications for mitral surgery.
BACKGROUND: Left atrial (LA) mechanics in patients with severe mitral regurgitation (MR) remain largely unexplored. The aim of the present evaluation was to assess the effect of severe MR on LA function, its potential relation with conventional surgical indications, and long-term postoperative survival. METHODS: Two-dimensional speckle-tracking strain and volumetric indices of LA reservoir, conduit, and contractile function were assessed in 121 patients with severe MR and 70 controls. Patients were divided according to the presence (n = 46) or absence (n = 75) of one or more guidelines-based criteria for mitral surgery (symptoms, left ventricular ejection fraction ≤ 60%, left ventricular end-systolic diameter ≥ 40 mm, atrial fibrillation, or systolic pulmonary arterial pressure >50 mm Hg). RESULTS: In patients with severe MR compared with controls, significant LA reservoir and contractile dysfunction was observed, which was more pronounced in patients with mitral surgery indication (P < .05 for all strain and volumetric indices). Of all indices of LA function, LA reservoir strain was an independent predictor (odds ratio, 0.88; 95% confidence interval, 0.82-0.94; P < .001) and had the highest accuracy to identify patients with indications for mitral surgery (area under the receiver operating characteristic curve, 0.8; 95% confidence interval, 0.72-0.87). A total of 117 patients underwent mitral valve surgery. Patients with LA reservoir strain ≤24% showed worse survival at a median of 6.4 years (interquartile range, 4.7-8.7 years) after mitral surgery (P = .02), regardless the symptomatic status before surgery. LA reservoir strain, on top of mitral surgery indications, provided incremental predictive value for postoperative survival. CONCLUSIONS: Impaired LA reservoir strain in patients with severe organic MR relates to long-term survival after mitral valve surgery, independently of and incremental to current guidelines-based indications for mitral surgery.
Authors: Francesco Bandera; Anita Mollo; Matteo Frigelli; Giulia Guglielmi; Nicoletta Ventrella; Maria Concetta Pastore; Matteo Cameli; Marco Guazzi Journal: Front Cardiovasc Med Date: 2022-01-13
Authors: K Nakamura; T Osuga; K Morishita; S Suzuki; T Morita; N Yokoyama; H Ohta; M Yamasaki; M Takiguchi Journal: J Vet Intern Med Date: 2014-10-18 Impact factor: 3.333
Authors: Maria Concetta Pastore; Giulia Elena Mandoli; Anna Sannino; Aleksander Dokollari; Gianluigi Bisleri; Flavio D'Ascenzi; Luna Cavigli; Annalisa Pasquini; Matteo Lisi; Nicolò Ghionzoli; Ciro Santoro; Marcelo Haertel Miglioranza; Marta Focardi; Giuseppe Patti; Serafina Valente; Sergio Mondillo; Matteo Cameli Journal: Front Cardiovasc Med Date: 2021-07-08
Authors: Gijs E De Maat; Stefano Benussi; Yoran M Hummel; Sebastien Krul; Alberto Pozzoli; Antoine H G Driessen; Massimo A Mariani; Isabelle C Van Gelder; Wim-Jan Van Boven; Joris R de Groot Journal: Biomed Res Int Date: 2015-07-07 Impact factor: 3.411
Authors: Roman Leischik; Henning Littwitz; Birgit Dworrak; Pankaj Garg; Meihua Zhu; David J Sahn; Marc Horlitz Journal: Biomed Res Int Date: 2015-07-07 Impact factor: 3.411