Giulia Elena Mandoli1, Maria Concetta Pastore2, Giovanni Benfari3, Gianluigi Bisleri4, Massimo Maccherini5, Gianfranco Lisi5, Paolo Cameli6, Matteo Lisi1, Aleksandr Dokollari7, Chiara Carrucola1, Mariangela Vigna1, Gianfranco Montesi5, Serafina Valente1, Sergio Mondillo1, Matteo Cameli1. 1. Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy. 2. Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy. Electronic address: pastore2411@gmail.com. 3. Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy. 4. Division of Cardiac Surgery, Queen's University Kingston Health Sciences Centre, Canada. 5. Department of Cardiac Surgery, University of Siena, Siena, Italy. 6. Department of Clinical Medical and Neurosciences, Respiratory Disease and Lung Transplantation Section, Le Scotte Hospital, University of Siena, Italy. 7. Cardiac Surgery, St. Michael Hospital, Toronto, ON, Canada.
Abstract
BACKGROUND: In patients with severe mitral regurgitation (MR), additional echocardiographic indices could be helpful to optimize surgical timing before irreversible left heart myocardial dysfunction has occurred. We investigated the correlation of left atrial (LA) strain by speckle tracking echocardiography with prognosis after mitral surgery for severe MR, and its association with LA fibrosis. METHOD: 71 patients with primary severe MR undergoing pre-operative echocardiographic assessment were initially enrolled. Exclusion criteria were: other valvular disease>moderate, history of coronary artery disease, heart failure (HF), hypertrophic cardiomyopathy, left bundle branch block, previous pacemaker implantation, heart transplantation, poor acoustic window. The primary endpoint was the occurrence of composite events (HF and mortality); the secondary endpoint was post-operative functional capacity (NYHA and Borg CR10 class). LA fibrosis was assessed by atrial biopsy specimens in a subset of patients. RESULTS: Of 65 eligible patients, the primary endpoint occurred in 30 patients (medium follow-up: 3.7 ± 1 years for event-group, 6.8 ± 1 years for non-event group). After Kaplan-Meier analysis, peak atrial longitudinal strain (PALS) provided good risk stratification (5-year event-free survival:90 ± 5% for PALS≥21% vs 30 ± 9% for PALS<21%, p < 0.0001); it was an independent and incremental predictor of outcome in four multivariate Cox adjusted models. There was also an association between PALS and the secondary endpoint (NYHA: r2 = 0.11, p = 0.04; Borg CR10: r2 = 0.10, p = 0.02) and an inverse correlation between PALS<21% and LA fibrosis (r2 0.80, fibrosis: 76.6 ± 20.7% vs 31.9 ± 20.8%;p < 0.0001). CONCLUSIONS: Global PALS emerged as a reliable predictor of outcome and functional capacity for severe primary MR, and as a marker of LA fibrosis.
BACKGROUND: In patients with severe mitral regurgitation (MR), additional echocardiographic indices could be helpful to optimize surgical timing before irreversible left heart myocardial dysfunction has occurred. We investigated the correlation of left atrial (LA) strain by speckle tracking echocardiography with prognosis after mitral surgery for severe MR, and its association with LA fibrosis. METHOD: 71 patients with primary severe MR undergoing pre-operative echocardiographic assessment were initially enrolled. Exclusion criteria were: other valvular disease>moderate, history of coronary artery disease, heart failure (HF), hypertrophic cardiomyopathy, left bundle branch block, previous pacemaker implantation, heart transplantation, poor acoustic window. The primary endpoint was the occurrence of composite events (HF and mortality); the secondary endpoint was post-operative functional capacity (NYHA and Borg CR10 class). LA fibrosis was assessed by atrial biopsy specimens in a subset of patients. RESULTS: Of 65 eligible patients, the primary endpoint occurred in 30 patients (medium follow-up: 3.7 ± 1 years for event-group, 6.8 ± 1 years for non-event group). After Kaplan-Meier analysis, peak atrial longitudinal strain (PALS) provided good risk stratification (5-year event-free survival:90 ± 5% for PALS≥21% vs 30 ± 9% for PALS<21%, p < 0.0001); it was an independent and incremental predictor of outcome in four multivariate Cox adjusted models. There was also an association between PALS and the secondary endpoint (NYHA: r2 = 0.11, p = 0.04; Borg CR10: r2 = 0.10, p = 0.02) and an inverse correlation between PALS<21% and LA fibrosis (r2 0.80, fibrosis: 76.6 ± 20.7% vs 31.9 ± 20.8%;p < 0.0001). CONCLUSIONS: Global PALS emerged as a reliable predictor of outcome and functional capacity for severe primary MR, and as a marker of LA fibrosis.
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: Giulia Elena Mandoli; Flavio D'Ascenzi; Giulia Vinco; Giovanni Benfari; Fabrizio Ricci; Marta Focardi; Luna Cavigli; Maria Concetta Pastore; Nicolò Sisti; Oreste De Vivo; Ciro Santoro; Sergio Mondillo; Matteo Cameli Journal: Front Cardiovasc Med Date: 2021-04-15
Authors: Maria Concetta Pastore; Giulia Elena Mandoli; Francesco Contorni; Luna Cavigli; Marta Focardi; Flavio D'Ascenzi; Giuseppe Patti; Sergio Mondillo; Matteo Cameli Journal: Biomed Res Int Date: 2021-02-02 Impact factor: 3.411