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Impact of Preoperative Left Atrial Dimension on Outcome in Patients in Sinus Rhythm Undergoing Surgical Valve Repair for Severe Mitral Regurgitation due to Mitral Valve Prolapse.

Abstract

BACKGROUND

Left atrial (LA) enlargement has been previously identified as a predictor of mortality in patients with medically managed mitral regurgitation (MR) due to mitral valve prolapse (MVP). No study has specifically assessed the prognostic value of LA size in patients undergoing mitral valve repair (MVRp).

OBJECTIVE

We aimed to investigate the relationship between LA area and mortality in patients in sinus rhythm (SR) undergoing MVRp for MVP.

METHODS

We included 305 patients in SR who underwent MVRp for MVP. Median follow-up time was 7.9 years. Patients were divided into 3 groups: LA area ≤25 cm2 (reference group), LA 26-30 cm2, and LA >30 cm2.

RESULTS

Compared with patients with an LA area ≤25 cm2, those with an LA area >30 cm2 had a lower 10-year survival (98 ± 2 vs. 86 ± 4%; p = 0.037). In multivariate analysis, after adjustment for established outcome predictors including age, symptoms, EuroSCORE, and left ventricular size and function, LA enlargement >30 cm2 was associated with increased mortality (adjusted HR = 2.20, 95% CI 1.03-4.90; p = 0.042), whereas LA enlargement between 26 and 30 cm2 was not (adjusted HR = 1.37, 95% CI 0.56-3.56; p = 0.52).

CONCLUSION

LA enlargement is independently predictive of long-term mortality after MVRp in patients in SR with severe MR due to MVP. Our findings suggest that MVRp should be considered before the LA area exceeds 30 cm2.

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  • Authors+Show Affiliations

    ,

    Department of Cardiology, Amiens University Hospital, Amiens, France.

    ,

    Department of Cardiology, Amiens University Hospital, Amiens, France. EA 7517 MP3CV Jules Verne University of Picardie, Amiens, France.

    ,

    Department of Cardiology, Amiens University Hospital, Amiens, France. EA 7517 MP3CV Jules Verne University of Picardie, Amiens, France.

    ,

    Department of Cardiac Surgery, Amiens University Hospital, Amiens, France.

    Department of Cardiology, Amiens University Hospital, Amiens, France, tribouilloy.christophe@chu-amiens.fr. EA 7517 MP3CV Jules Verne University of Picardie, Amiens, France, tribouilloy.christophe@chu-amiens.fr.

    Source

    Cardiology 142:3 pg 189-193

    Pub Type(s)

    News

    Language

    eng

    PubMed ID

    31230053

    Citation

    Szymanski, Catherine, et al. "Impact of Preoperative Left Atrial Dimension On Outcome in Patients in Sinus Rhythm Undergoing Surgical Valve Repair for Severe Mitral Regurgitation Due to Mitral Valve Prolapse." Cardiology, vol. 142, no. 3, 2019, pp. 189-193.
    Szymanski C, Bohbot Y, Rusinaru D, et al. Impact of Preoperative Left Atrial Dimension on Outcome in Patients in Sinus Rhythm Undergoing Surgical Valve Repair for Severe Mitral Regurgitation due to Mitral Valve Prolapse. Cardiology. 2019;142(3):189-193.
    Szymanski, C., Bohbot, Y., Rusinaru, D., Touati, G., & Tribouilloy, C. (2019). Impact of Preoperative Left Atrial Dimension on Outcome in Patients in Sinus Rhythm Undergoing Surgical Valve Repair for Severe Mitral Regurgitation due to Mitral Valve Prolapse. Cardiology, 142(3), pp. 189-193. doi:10.1159/000499577.
    Szymanski C, et al. Impact of Preoperative Left Atrial Dimension On Outcome in Patients in Sinus Rhythm Undergoing Surgical Valve Repair for Severe Mitral Regurgitation Due to Mitral Valve Prolapse. Cardiology. 2019;142(3):189-193. PubMed PMID: 31230053.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Impact of Preoperative Left Atrial Dimension on Outcome in Patients in Sinus Rhythm Undergoing Surgical Valve Repair for Severe Mitral Regurgitation due to Mitral Valve Prolapse. AU - Szymanski,Catherine, AU - Bohbot,Yohann, AU - Rusinaru,Dan, AU - Touati,Gilles, AU - Tribouilloy,Christophe, Y1 - 2019/06/21/ PY - 2018/12/20/received PY - 2019/03/13/accepted PY - 2019/6/24/pubmed PY - 2019/6/24/medline PY - 2019/6/24/entrez KW - Left atrial area KW - Mitral regurgitation KW - Mitral valve prolapse KW - Mitral valve repair KW - Outcome SP - 189 EP - 193 JF - Cardiology JO - Cardiology VL - 142 IS - 3 N2 - BACKGROUND: Left atrial (LA) enlargement has been previously identified as a predictor of mortality in patients with medically managed mitral regurgitation (MR) due to mitral valve prolapse (MVP). No study has specifically assessed the prognostic value of LA size in patients undergoing mitral valve repair (MVRp). OBJECTIVE: We aimed to investigate the relationship between LA area and mortality in patients in sinus rhythm (SR) undergoing MVRp for MVP. METHODS: We included 305 patients in SR who underwent MVRp for MVP. Median follow-up time was 7.9 years. Patients were divided into 3 groups: LA area ≤25 cm2 (reference group), LA 26-30 cm2, and LA >30 cm2. RESULTS: Compared with patients with an LA area ≤25 cm2, those with an LA area >30 cm2 had a lower 10-year survival (98 ± 2 vs. 86 ± 4%; p = 0.037). In multivariate analysis, after adjustment for established outcome predictors including age, symptoms, EuroSCORE, and left ventricular size and function, LA enlargement >30 cm2 was associated with increased mortality (adjusted HR = 2.20, 95% CI 1.03-4.90; p = 0.042), whereas LA enlargement between 26 and 30 cm2 was not (adjusted HR = 1.37, 95% CI 0.56-3.56; p = 0.52). CONCLUSION: LA enlargement is independently predictive of long-term mortality after MVRp in patients in SR with severe MR due to MVP. Our findings suggest that MVRp should be considered before the LA area exceeds 30 cm2. SN - 1421-9751 UR - https://www.unboundmedicine.com/medline/citation/31230053/Impact_of_Preoperative_Left_Atrial_Dimension_on_Outcome_in_Patients_in_Sinus_Rhythm_Undergoing_Surgical_Valve_Repair_for_Severe_Mitral_Regurgitation_due_to_Mitral_Valve_Prolapse L2 - https://www.karger.com?DOI=10.1159/000499577 DB - PRIME DP - Unbound Medicine ER -