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Left atrial function by two-dimensional speckle-tracking echocardiography in patients with severe organic mitral regurgitation: association with guidelines-based surgical indication and postoperative (long-term) survival.
J Am Soc Echocardiogr 2013; 26(9):1053-62JA

Abstract

BACKGROUND

Left atrial (LA) mechanics in patients with severe mitral regurgitation (MR) remain largely unexplored. The aim of the present evaluation was to assess the effect of severe MR on LA function, its potential relation with conventional surgical indications, and long-term postoperative survival.

METHODS

Two-dimensional speckle-tracking strain and volumetric indices of LA reservoir, conduit, and contractile function were assessed in 121 patients with severe MR and 70 controls. Patients were divided according to the presence (n = 46) or absence (n = 75) of one or more guidelines-based criteria for mitral surgery (symptoms, left ventricular ejection fraction ≤ 60%, left ventricular end-systolic diameter ≥ 40 mm, atrial fibrillation, or systolic pulmonary arterial pressure >50 mm Hg).

RESULTS

In patients with severe MR compared with controls, significant LA reservoir and contractile dysfunction was observed, which was more pronounced in patients with mitral surgery indication (P < .05 for all strain and volumetric indices). Of all indices of LA function, LA reservoir strain was an independent predictor (odds ratio, 0.88; 95% confidence interval, 0.82-0.94; P < .001) and had the highest accuracy to identify patients with indications for mitral surgery (area under the receiver operating characteristic curve, 0.8; 95% confidence interval, 0.72-0.87). A total of 117 patients underwent mitral valve surgery. Patients with LA reservoir strain ≤24% showed worse survival at a median of 6.4 years (interquartile range, 4.7-8.7 years) after mitral surgery (P = .02), regardless the symptomatic status before surgery. LA reservoir strain, on top of mitral surgery indications, provided incremental predictive value for postoperative survival.

CONCLUSIONS

Impaired LA reservoir strain in patients with severe organic MR relates to long-term survival after mitral valve surgery, independently of and incremental to current guidelines-based indications for mitral surgery.

Authors+Show Affiliations

Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.No 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)

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

Language

eng

PubMed ID

23860096

Citation

Debonnaire, Philippe, et al. "Left Atrial Function By Two-dimensional Speckle-tracking Echocardiography in Patients With Severe Organic Mitral Regurgitation: Association With Guidelines-based Surgical Indication and Postoperative (long-term) Survival." Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography, vol. 26, no. 9, 2013, pp. 1053-62.
Debonnaire P, Leong DP, Witkowski TG, et al. Left atrial function by two-dimensional speckle-tracking echocardiography in patients with severe organic mitral regurgitation: association with guidelines-based surgical indication and postoperative (long-term) survival. J Am Soc Echocardiogr. 2013;26(9):1053-62.
Debonnaire, P., Leong, D. P., Witkowski, T. G., Al Amri, I., Joyce, E., Katsanos, S., ... Marsan, N. A. (2013). Left atrial function by two-dimensional speckle-tracking echocardiography in patients with severe organic mitral regurgitation: association with guidelines-based surgical indication and postoperative (long-term) survival. Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography, 26(9), pp. 1053-62. doi:10.1016/j.echo.2013.05.019.
Debonnaire P, et al. Left Atrial Function By Two-dimensional Speckle-tracking Echocardiography in Patients With Severe Organic Mitral Regurgitation: Association With Guidelines-based Surgical Indication and Postoperative (long-term) Survival. J Am Soc Echocardiogr. 2013;26(9):1053-62. PubMed PMID: 23860096.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Left atrial function by two-dimensional speckle-tracking echocardiography in patients with severe organic mitral regurgitation: association with guidelines-based surgical indication and postoperative (long-term) survival. AU - Debonnaire,Philippe, AU - Leong,Darryl P, AU - Witkowski,Tomasz G, AU - Al Amri,Ibtihal, AU - Joyce,Emer, AU - Katsanos,Spyridon, AU - Schalij,Martin J, AU - Bax,Jeroen J, AU - Delgado,Victoria, AU - Marsan,Nina Ajmone, Y1 - 2013/07/13/ PY - 2012/11/21/received PY - 2013/7/18/entrez PY - 2013/7/19/pubmed PY - 2014/1/1/medline KW - 2D KW - Atrium KW - CI KW - Confidence interval KW - LA KW - LAVI KW - LV KW - LVEF KW - Left atrial KW - Left atrial volume indexed to body surface area KW - Left ventricular KW - Left ventricular ejection fraction KW - MR KW - Mitral regurgitation KW - Mitral valve KW - OR KW - Odds ratio KW - Regurgitation KW - Strain KW - Surgery KW - Two-dimensional SP - 1053 EP - 62 JF - Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography JO - J Am Soc Echocardiogr VL - 26 IS - 9 N2 - BACKGROUND: Left atrial (LA) mechanics in patients with severe mitral regurgitation (MR) remain largely unexplored. The aim of the present evaluation was to assess the effect of severe MR on LA function, its potential relation with conventional surgical indications, and long-term postoperative survival. METHODS: Two-dimensional speckle-tracking strain and volumetric indices of LA reservoir, conduit, and contractile function were assessed in 121 patients with severe MR and 70 controls. Patients were divided according to the presence (n = 46) or absence (n = 75) of one or more guidelines-based criteria for mitral surgery (symptoms, left ventricular ejection fraction ≤ 60%, left ventricular end-systolic diameter ≥ 40 mm, atrial fibrillation, or systolic pulmonary arterial pressure >50 mm Hg). RESULTS: In patients with severe MR compared with controls, significant LA reservoir and contractile dysfunction was observed, which was more pronounced in patients with mitral surgery indication (P < .05 for all strain and volumetric indices). Of all indices of LA function, LA reservoir strain was an independent predictor (odds ratio, 0.88; 95% confidence interval, 0.82-0.94; P < .001) and had the highest accuracy to identify patients with indications for mitral surgery (area under the receiver operating characteristic curve, 0.8; 95% confidence interval, 0.72-0.87). A total of 117 patients underwent mitral valve surgery. Patients with LA reservoir strain ≤24% showed worse survival at a median of 6.4 years (interquartile range, 4.7-8.7 years) after mitral surgery (P = .02), regardless the symptomatic status before surgery. LA reservoir strain, on top of mitral surgery indications, provided incremental predictive value for postoperative survival. CONCLUSIONS: Impaired LA reservoir strain in patients with severe organic MR relates to long-term survival after mitral valve surgery, independently of and incremental to current guidelines-based indications for mitral surgery. SN - 1097-6795 UR - https://www.unboundmedicine.com/medline/citation/23860096/Left_atrial_function_by_two_dimensional_speckle_tracking_echocardiography_in_patients_with_severe_organic_mitral_regurgitation:_association_with_guidelines_based_surgical_indication_and_postoperative__long_term__survival_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0894-7317(13)00407-0 DB - PRIME DP - Unbound Medicine ER -