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Impact of left atrial volume on clinical outcome in organic mitral regurgitation.
J Am Coll Cardiol 2010; 56(7):570-8JACC

Abstract

OBJECTIVES

The purpose of this paper was to assess the link between left atrial (LA) volume at diagnosis and outcome of patients with mitral regurgitation (MR).

BACKGROUND

Left atrial enlargement is a consequence of organic MR, but its association with clinical outcome independently of MR severity is uncertain.

METHODS

We prospectively enrolled 492 patients (age 63 +/- 15 years, 60% men) in sinus rhythm with organic MR (regurgitant volume 68 +/- 42 ml/beat) and performed at baseline triple echocardiographic quantitation (MR severity, LA volume, and left ventricular characteristics). Outcome with medical and surgical management was analyzed.

RESULTS

Left atrial volume indexed to body surface area (LA index) was 55 +/- 26 ml/m(2) (<40 ml/m(2) in 158 patients, 40 to 59 ml/m(2) in 160 patients, and > or =60 ml/m(2) in 174 patients). Under medical management, 5-year survival was 80 +/- 2.9% and cardiac events 28 +/- 3%. Adjusting for established predictors of outcome, LA index was independently associated with survival after diagnosis (hazard ratio [HR]: 1.3 [95% confidence interval (CI): 1.1 to 1.5] per 10 ml/m(2) increment, p = 0.001). Patients with LA index > or =60 ml/m(2) had lower 5-year survival than those with no or mild LA enlargement (p < 0.0001) and than the rates of survival expected in the U.S. population (53 +/- 8.6% vs. 76%, p = 0.017). Compared with patients with LA index <40 ml/m(2), those with LA index > or =60 ml/m(2) had increased mortality (HR: 2.8 [95% CI: 1.2 to 6.5], p = 0.016) and cardiac events (HR: 5.2 [95% CI: 2.6 to 10.9], p < 0.0001) with medical management. Mitral surgery was associated with decreased mortality (HR: 0.46 [95% CI: 0.26 to 0.84], p = 0.01) and cardiac events (HR: 0.38 [95% CI: 0.23 to 0.62], p = 0.0001) and after surgery patients with LA index > or =60 ml/m(2) versus <60 ml/m(2) did not incur excess mortality or cardiac events (both p > 0.30).

CONCLUSIONS

In organic MR, LA index at diagnosis predicts long-term outcome, incrementally to known predictors of outcome. This marker of risk is particularly important because mitral surgery in these patients markedly improves outcome and restores life expectancy. LA index should be measured in routine clinical practice for risk-stratification and for clinical decision making in patients with organic MR.

Authors+Show Affiliations

Division of Cardiovascular Diseases, Section of Biostatistics, and Cardiovascular Surgery Division, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20688212

Citation

Le Tourneau, Thierry, et al. "Impact of Left Atrial Volume On Clinical Outcome in Organic Mitral Regurgitation." Journal of the American College of Cardiology, vol. 56, no. 7, 2010, pp. 570-8.
Le Tourneau T, Messika-Zeitoun D, Russo A, et al. Impact of left atrial volume on clinical outcome in organic mitral regurgitation. J Am Coll Cardiol. 2010;56(7):570-8.
Le Tourneau, T., Messika-Zeitoun, D., Russo, A., Detaint, D., Topilsky, Y., Mahoney, D. W., ... Enriquez-Sarano, M. (2010). Impact of left atrial volume on clinical outcome in organic mitral regurgitation. Journal of the American College of Cardiology, 56(7), pp. 570-8. doi:10.1016/j.jacc.2010.02.059.
Le Tourneau T, et al. Impact of Left Atrial Volume On Clinical Outcome in Organic Mitral Regurgitation. J Am Coll Cardiol. 2010 Aug 10;56(7):570-8. PubMed PMID: 20688212.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of left atrial volume on clinical outcome in organic mitral regurgitation. AU - Le Tourneau,Thierry, AU - Messika-Zeitoun,David, AU - Russo,Antonio, AU - Detaint,Delphine, AU - Topilsky,Yan, AU - Mahoney,Douglas W, AU - Suri,Rakesh, AU - Enriquez-Sarano,Maurice, PY - 2009/02/17/received PY - 2010/02/04/revised PY - 2010/02/08/accepted PY - 2010/8/7/entrez PY - 2010/8/7/pubmed PY - 2010/9/16/medline SP - 570 EP - 8 JF - Journal of the American College of Cardiology JO - J. Am. Coll. Cardiol. VL - 56 IS - 7 N2 - OBJECTIVES: The purpose of this paper was to assess the link between left atrial (LA) volume at diagnosis and outcome of patients with mitral regurgitation (MR). BACKGROUND: Left atrial enlargement is a consequence of organic MR, but its association with clinical outcome independently of MR severity is uncertain. METHODS: We prospectively enrolled 492 patients (age 63 +/- 15 years, 60% men) in sinus rhythm with organic MR (regurgitant volume 68 +/- 42 ml/beat) and performed at baseline triple echocardiographic quantitation (MR severity, LA volume, and left ventricular characteristics). Outcome with medical and surgical management was analyzed. RESULTS: Left atrial volume indexed to body surface area (LA index) was 55 +/- 26 ml/m(2) (<40 ml/m(2) in 158 patients, 40 to 59 ml/m(2) in 160 patients, and > or =60 ml/m(2) in 174 patients). Under medical management, 5-year survival was 80 +/- 2.9% and cardiac events 28 +/- 3%. Adjusting for established predictors of outcome, LA index was independently associated with survival after diagnosis (hazard ratio [HR]: 1.3 [95% confidence interval (CI): 1.1 to 1.5] per 10 ml/m(2) increment, p = 0.001). Patients with LA index > or =60 ml/m(2) had lower 5-year survival than those with no or mild LA enlargement (p < 0.0001) and than the rates of survival expected in the U.S. population (53 +/- 8.6% vs. 76%, p = 0.017). Compared with patients with LA index <40 ml/m(2), those with LA index > or =60 ml/m(2) had increased mortality (HR: 2.8 [95% CI: 1.2 to 6.5], p = 0.016) and cardiac events (HR: 5.2 [95% CI: 2.6 to 10.9], p < 0.0001) with medical management. Mitral surgery was associated with decreased mortality (HR: 0.46 [95% CI: 0.26 to 0.84], p = 0.01) and cardiac events (HR: 0.38 [95% CI: 0.23 to 0.62], p = 0.0001) and after surgery patients with LA index > or =60 ml/m(2) versus <60 ml/m(2) did not incur excess mortality or cardiac events (both p > 0.30). CONCLUSIONS: In organic MR, LA index at diagnosis predicts long-term outcome, incrementally to known predictors of outcome. This marker of risk is particularly important because mitral surgery in these patients markedly improves outcome and restores life expectancy. LA index should be measured in routine clinical practice for risk-stratification and for clinical decision making in patients with organic MR. SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/20688212/Impact_of_left_atrial_volume_on_clinical_outcome_in_organic_mitral_regurgitation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(10)02084-X DB - PRIME DP - Unbound Medicine ER -