Li-Tan Yang1, Yen-Wen Liu2, Jhih-Yuan Shih3, Yi-Heng Li2, Liang-Miin Tsai2, Chwan-Yau Luo4, Wei-Chuan Tsai5. 1. Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Internal Medicine, Tainan Hospital, Tainan, Taiwan. 2. Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan. 3. Department of Internal Medicine, Chi-Mei Hospital, Tainan, Taiwan. 4. Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan. 5. Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan. Electronic address: wctsai@seed.net.tw.
Abstract
BACKGROUND: Impaired left atrial (LA) deformation is noted in patients with severe primary mitral regurgitation (MR), but its prognostic value is unknown. The aim of this study was to investigate the prognostic significance of LA deformation parameters in patients with chronic severe primary MR. METHODS: A total of 104 patients with asymptomatic chronic severe primary MR (Carpentier type II) and preserved left ventricular systolic function were prospectively recruited. Global peak positive strain of the left atrium (LASp) and strain rate in the LA filling phase (LASRr) as well as strain rate in the LA conduit phase were identified using two-dimensional speckle-tracking echocardiography. RESULTS: During a mean follow-up period of 13.2 ± 9.5 months, 22 patients reached a composite end point of death and mitral valve repair or replacement prompted by heart failure development. Among the clinical and echocardiographic parameters, LV end-systolic volume index (19.5 ± 9.5 vs 15.7 ± 6.3 mL/m(2), P = .028), LASp (22.7 ± 10.4% vs 27.2 ± 9.1%, P = .049), and LASRr (1.97 ± 0.6 vs 2.33 ± 0.6 1/sec, P = .013) varied between the two groups in terms of end points but not age, LA volume index, left ventricular ejection fraction, pulmonary artery systolic pressure, and presence of atrial fibrillation. After multivariate analysis, low LASp (odds ratio, 3.606; 95% CI, 1.294-10.052; P = .014) and low LASRr (odds ratio, 2.857; 95% CI, 1.078-7.572; P = .035) remained powerful outcome indicators. CONCLUSIONS: In patients with asymptomatic severe primary MR, reduced LASp and LASRr predicted a worse prognosis. These findings may offer additional information to guide early surgery.
BACKGROUND: Impaired left atrial (LA) deformation is noted in patients with severe primary mitral regurgitation (MR), but its prognostic value is unknown. The aim of this study was to investigate the prognostic significance of LA deformation parameters in patients with chronic severe primary MR. METHODS: A total of 104 patients with asymptomatic chronic severe primary MR (Carpentier type II) and preserved left ventricular systolic function were prospectively recruited. Global peak positive strain of the left atrium (LASp) and strain rate in the LA filling phase (LASRr) as well as strain rate in the LA conduit phase were identified using two-dimensional speckle-tracking echocardiography. RESULTS: During a mean follow-up period of 13.2 ± 9.5 months, 22 patients reached a composite end point of death and mitral valve repair or replacement prompted by heart failure development. Among the clinical and echocardiographic parameters, LV end-systolic volume index (19.5 ± 9.5 vs 15.7 ± 6.3 mL/m(2), P = .028), LASp (22.7 ± 10.4% vs 27.2 ± 9.1%, P = .049), and LASRr (1.97 ± 0.6 vs 2.33 ± 0.6 1/sec, P = .013) varied between the two groups in terms of end points but not age, LA volume index, left ventricular ejection fraction, pulmonary artery systolic pressure, and presence of atrial fibrillation. After multivariate analysis, low LASp (odds ratio, 3.606; 95% CI, 1.294-10.052; P = .014) and low LASRr (odds ratio, 2.857; 95% CI, 1.078-7.572; P = .035) remained powerful outcome indicators. CONCLUSIONS: In patients with asymptomatic severe primary MR, reduced LASp and LASRr predicted a worse prognosis. These findings may offer additional information to guide early 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
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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