Predictive Value of Left Atrial Deformation on Prognosis in Severe Primary Mitral Regurgitation - 03/11/15
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/m2, 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.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Impaired LA deformation was related to stepwise decline in baseline functional capacity in severe primary MR in a previous study. |
• | The prognostic impact of LA deformation parameters in asymptomatic patients with chronic severe primary MR was investigated. |
• | Reduced LASp and LASRr outperformed other conventional parameters included in current guidelines in predicting future death or MV surgery. |
• | LASp and LASRr may be promising noninvasive tools to assist in patient-tailored surgical decision making when current consensus-based guidance is uncertain. |
Keywords : Left atrium, Mitral regurgitation, Strain rate, Speckle-tracking echocardiography
Abbreviations : AF, GLS, LA, LASp, LASRc, LASRr, LAVd, LAVi, LAVs, LV, LVEF, LVESVi, MR, MV, PASP, STE, 2D
Plan
| This study was supported by grant NSC 101-2314-B-006-074 from the National Science Council, Executive Yuan, Taipei, and grant NCKUH-10302001 from the National Cheng Kung University Hospital, Tainan, Taiwan. |
Vol 28 - N° 11
P. 1309 - novembre 2015 Retour au numéro
Article précédent
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