Prognostic value of left atrial strain in patients with moderate asymptomatic mitral regurgitation
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For patients with asymptomatic mitral regurgitation (MR), the criteria identifying the groups at higher-risk and their clinical outcome are still uncertain. Therefore, in these patients, optimal time of surgery remains controversial. The purpose of this study was to compare left atrial (LA) strain to other echocardiographic left ventricular (LV) and LA parameters for the prediction of cardiovascular outcomes in patients with moderate asymptomatic MR. We enrolled 395 patients with primary degenerative moderate asymptomatic MR. Exclusion criteria were: history of atrial fibrillation, myocardial infarction, heart failure, cardiac surgery or heart transplantation, severe MR, mitral valve surgery during follow-up. Patients were prospectively followed for 3.5 ± 1.6 years for the development of cardiovascular events i.e. atrial fibrillation, stroke/transient ischaemic attack, acute heart failure, cardiovascular death. Of 276 patients (mean age 66 ± 8 years) who met eligibility criteria, 108 patients had 141 new events. Patients who developed cardiovascular events presented reduced global peak atrial longitudinal strain (PALS), reduced LA emptying fraction, larger LA volume indexed and lower LV strain at baseline (p < 0.0001). With receiving operating characteristics (ROC) curve analysis, global PALS < 35% showed the greatest predictive performance (AUC global PALS: 0.87). Bland–Altman analysis demonstrated good intra- and interobserver agreement with small bias and Kaplan–Meier analysis showed a graded association between PALS and event-free-survival rates. Speckle tracking imaging could provide a useful index, global PALS, to estimate LA function in asymptomatic moderate MR in order to optimize timing of surgery before the development of irreversible myocardial dysfunction.
KeywordsMitral regurgitation Prognosis Speckle tracking Left atrial dysfunction Mitral surgery timing
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 2.Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Fleisher LA (2017) 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 70(2):252–289CrossRefGoogle Scholar
- 7.Ramu B, Elwan AM, Coleman CI, Silverman DI, Gluck JA (2015) The association between baseline left atrial volume index and all-cause mortality in patients with heart failure: a meta-analysis. Conn Med 79(8):469–475Google Scholar
- 8.Dardas PS, Pitsis AA, Tsikaderis DD, Mezilis NE, Geleris PN, Boudoulas HK (2004) Left atrial volumes, function and work before and after mitral valve repair in chronic mitral regurgitation. J Heart Valve Dis 13:27–32Google Scholar
- 9.Di Gioia G, Mega S, Nenna A, Campanale CM, Colaiori I, Scordino D, Ragni L, Miglionico M, Di Sciascio G (2017) Should pre-operative left atrial volume receive more consideration in patients with degenerative mitral valve disease undergoing mitral valve surgery? Int J Cardiol 227:106–113CrossRefGoogle Scholar
- 10.Cameli M, Lisi M, Righini FM, Mondillo S (2012) Novel echocardiographic techniques to assess left atrial size, anatomy and function. Cardiovasc Ultrasound 1:10–14Google Scholar
- 11.Zoghbi WA, Adams D, Bonow RO, Enriquez-Sarano M, Foster E, Grayburn PA, Hahn RT, Han Y, Hung J, Lang RM, Little SH, Shah DJ, Shernan S, Thavendiranathan P, Thomas JD, Weissman NJ (2017) Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr 30(4):303–371CrossRefGoogle Scholar
- 13.Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ, Chamber Quantification Writing Group, American Society of Echocardiography’s Guidelines and Standards Committee, European Association of Echocardiography, Recommendations for Chamber Quantification (2005) A report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, Developed in Conjunction with the European Association of Echocardiography, a Branch of the European Society of Cardiology. J Am Soc Echocardiogr 18(12):1440–1463CrossRefGoogle Scholar
- 14.Quinones MA, Otto CM, Stoddard M, Waggoner A, Zoghbi WA (2002) Recommendations for quantification of Doppler echocardiography: a report from the Doppler quantification Task force of the Nomenclature and Standards Committe of the American Society of Echocardiography. J Am Soc Echocardiogr 15:167–184CrossRefGoogle Scholar
- 16.Kasner M, Westermann D, Steendijk P, Gaub R, Wilkenshoff U, Weitmann K, Hoffmann W, Poller W, Schultheiss HP, Pauschinger M, Tschöpe C (2007) Utility of Doppler echocardiography and tissue Doppler imaging in the estimation of diastolic function in heart failure with normal ejection fraction: a comparative Doppler-conductance catheterization study. Circulation 116(6):637–647CrossRefGoogle Scholar
- 17.Ommen SR, Nishimura RA, Appleton CP, Miller FA, Oh JK, Redfield MM, Tajik AJ (2000) Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: a comparative simultaneous Doppler-catheterization study. Circulation 102:1788–1794CrossRefGoogle Scholar
- 19.Badano LP, Kolias TJ, Muraru D, Abraham TP, Aurigemma G, Edvardsen T, D’Hooge J, Donal E, Fraser AG, Marwick T, Mertens L, Popescu BA, Sengupta PP, Lancellotti P, Thomas JD, Voigt JU, Industry representatives Reviewers: This document was reviewed by members of the 2016–2018 EACVI Scientific Documents Committee (2018) Standardization of left atrial, right ventricular, and right atrial deformation imaging using two-dimensional speckle tracking echocardiography: a consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging. 19(6):591–600Google Scholar
- 22.Le Bihan DC, Della Togna DJ, Barretto RB, Assef JE, Machado LR, Abdulmassih Ramos AI, Neto C, Moisés VA, Sousa AG, Campos O (2015) Early improvement in left atrial remodeling and function after mitral valve repair or replacement in organic symptomatic mitral regurgitation assessed by three-dimensional echocardiography. Echocardiography. 32(7):1122–1130CrossRefGoogle Scholar
- 27.Cameli M, Lisi M, Righini FM, Massoni A, Natali B, Focardi M, Tacchini D, Geyer A, Curci V, Di Tommaso C, Lisi G, Maccherini M, Chiavarelli M, Massetti M, Tanganelli P, Mondillo S (2013) Usefulness of atrial deformation analysis to predict left atrial fibrosis and endocardial thickness in patients undergoing mitral valve operations for severe mitral regurgitation secondary to mitral valve prolapse. Am J Cardiol 111:595–601CrossRefGoogle Scholar