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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 2013; 111(4):595-601AJ

Abstract

In patients with severe mitral regurgitation (MR) referred for cardiac surgery, left atrial (LA) remodeling and enlargement are accompanied by mechanical stress, mediated cellular hypertrophy, and interstitial fibrosis that finally lead to LA failure. Speckle tracking echocardiography is a novel non-Doppler-based method that allows an objective quantification of LA myocardial deformation, becoming useful for LA functional analysis. We conducted a study to evaluate the relation between the traditional and novel atrial indexes and the extent of ultrastructural alterations, obtained from patients with severe MR who were undergoing surgical correction of the valvular disease. The study population included 46 patients with severe MR, referred to our echocardiographic laboratory for a diagnostic examination before cardiac surgery. The global peak atrial longitudinal strain (PALS) was measured in all subjects by averaging all atrial segments. LA tissue samples were obtained from all patients. Masson's trichrome staining was performed to assess the extent of the fibrosis. The LA endocardial thickness was measured. A close negative correlation between the global PALS and grade of LA myocardial fibrosis was found (r = -0.82, p <0.0001), with poorer correlations for the LA indexed volume (r = 0.51, p = 0.01), LA ejection fraction (r = 0.61, p = 0.005), and E/E' ratio (0.14, p = NS). Of these indexes, global PALS showed the best diagnostic accuracy to detect LA fibrosis (area under the curve 0.89), and it appears to be a strong and independent predictor of LA fibrosis. Furthermore, we also demonstrated an inverse correlation between the global PALS and LA endocardial thickness (r = -0.66, p = 0.0001). In conclusion, in patients with severe MR referred for cardiac surgery, impairment of LA longitudinal deformation, as assessed by the global PALS, correlated strongly with the extent of LA fibrosis and remodeling.

Authors+Show Affiliations

Department of Cardiovascular Diseases, University of Siena, Siena, Italy. cameli@cheapnet.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

23211360

Citation

Cameli, Matteo, et al. "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." The American Journal of Cardiology, vol. 111, no. 4, 2013, pp. 595-601.
Cameli M, Lisi M, Righini FM, et al. 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. 2013;111(4):595-601.
Cameli, M., Lisi, M., Righini, F. M., Massoni, A., Natali, B. M., Focardi, M., ... 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. The American Journal of Cardiology, 111(4), pp. 595-601. doi:10.1016/j.amjcard.2012.10.049.
Cameli M, et al. 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. 2013 Feb 15;111(4):595-601. PubMed PMID: 23211360.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Cameli,Matteo, AU - Lisi,Matteo, AU - Righini,Francesca Maria, AU - Massoni,Alberto, AU - Natali,Benedetta Maria, AU - Focardi,Marta, AU - Tacchini,Damiana, AU - Geyer,Alessia, AU - Curci,Valeria, AU - Di Tommaso,Cristina, AU - Lisi,Gianfranco, AU - Maccherini,Massimo, AU - Chiavarelli,Mario, AU - Massetti,Massimo, AU - Tanganelli,Piero, AU - Mondillo,Sergio, Y1 - 2012/12/01/ PY - 2012/06/07/received PY - 2012/10/22/revised PY - 2012/10/22/accepted PY - 2012/12/6/entrez PY - 2012/12/6/pubmed PY - 2013/4/16/medline SP - 595 EP - 601 JF - The American journal of cardiology JO - Am. J. Cardiol. VL - 111 IS - 4 N2 - In patients with severe mitral regurgitation (MR) referred for cardiac surgery, left atrial (LA) remodeling and enlargement are accompanied by mechanical stress, mediated cellular hypertrophy, and interstitial fibrosis that finally lead to LA failure. Speckle tracking echocardiography is a novel non-Doppler-based method that allows an objective quantification of LA myocardial deformation, becoming useful for LA functional analysis. We conducted a study to evaluate the relation between the traditional and novel atrial indexes and the extent of ultrastructural alterations, obtained from patients with severe MR who were undergoing surgical correction of the valvular disease. The study population included 46 patients with severe MR, referred to our echocardiographic laboratory for a diagnostic examination before cardiac surgery. The global peak atrial longitudinal strain (PALS) was measured in all subjects by averaging all atrial segments. LA tissue samples were obtained from all patients. Masson's trichrome staining was performed to assess the extent of the fibrosis. The LA endocardial thickness was measured. A close negative correlation between the global PALS and grade of LA myocardial fibrosis was found (r = -0.82, p <0.0001), with poorer correlations for the LA indexed volume (r = 0.51, p = 0.01), LA ejection fraction (r = 0.61, p = 0.005), and E/E' ratio (0.14, p = NS). Of these indexes, global PALS showed the best diagnostic accuracy to detect LA fibrosis (area under the curve 0.89), and it appears to be a strong and independent predictor of LA fibrosis. Furthermore, we also demonstrated an inverse correlation between the global PALS and LA endocardial thickness (r = -0.66, p = 0.0001). In conclusion, in patients with severe MR referred for cardiac surgery, impairment of LA longitudinal deformation, as assessed by the global PALS, correlated strongly with the extent of LA fibrosis and remodeling. SN - 1879-1913 UR - https://www.unboundmedicine.com/medline/citation/23211360/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_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9149(12)02337-5 DB - PRIME DP - Unbound Medicine ER -