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Mitral regurgitation severity correlates with symptoms and extent of left atrial dysfunction: Effect of mitral valve repair
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Department of Cardiovascular Disease, University of Siena, Italy .
Department of Cardiovascular Disease, University of Siena, Italy .
Department of Cardiovascular Disease, University of Siena, Italy .
Department of Cardiovascular Disease, University of Siena, Italy .
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2016 (English)Manuscript (preprint) (Other academic)
Abstract [en]

Purpose: We aimed to assess the relationship between mitral regurgitation (MR) severity, symptoms and left atrial (LA) structure and function, before and after mitral valve repair (MVR).

Methods: Global peak atrial longitudinal strain (PALS) was evaluated in 37 patients with severe symptomatic MR and preserved left ventricular (LV)EF (60.4±4.6%) before and 3 months after MVR and was compared with values from 30 age- and gender-matched controls.

Results: Before surgery, global PALS was reduced and indexed LA volume was increased (p<0.0001 for both). After MVR, both fell (p=0.001 and p=0.05, respectively) as did LVEF, longitudinal strain (LS) (p=0.05 and p<0.001, respectively) and LV mass (LVM) (p<0.0001).

Before surgery, LA volume correlated modestly with LV end-diastolic volume (R=0.51; p=0.01); EROA correlated with PALS (R=-0.69,p<0.001) and with LV LS (R=0.54,p=0.01); and NYHA class correlated with PALS (R=-0.69,p<0.001), EROA (R=0.69, p<0.001), and with LA volume (R=0.51, p=0.04). LA volume was the strongest predictor of global PALS reduction (p<0.001) while global PALS was the main predictor of post-operative atrial fibrillation (AF) (p<0.001),

Conclusions: In patients with severe MR, EROA correlate with symptoms and LA PALS which itself predicts the occurrence of post-operative AF. Strain values were superior to 2D-data for the prediction of post-operative AF.

 

Place, publisher, year, edition, pages
2016.
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:umu:diva-127291OAI: oai:DiVA.org:umu-127291DiVA: diva2:1044684
Available from: 2016-11-04 Created: 2016-11-04 Last updated: 2016-11-09
In thesis
1. Insights into left atrial response to pressure and volume overload
Open this publication in new window or tab >>Insights into left atrial response to pressure and volume overload
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The general purpose of this thesis is to establish the ability of Speckle Tracking Echocardiography (STE) in assessing left atrial (LA) response to pressure and volume overload respectively in aortic stenosis (AS) and mitral regurgitation (MR), and to evaluate its accuracy in predicting LA and right ventricular (RV) fibrosis in patients with end-stage heart failure (HF) undergoing heart transplantation (HTx).

I demonstrated that assessment of left ventricular (LV) long axis systolic velocity and amplitude of excursion is more sensitive than simple determination of ejection fraction (EF) for revealing the beneficial impact of MR surgery on overall LV systolic performance.

Severe symptomatic AS is associated with LA enlargement and compromised mechanical function with a high incidence of peri-operative atrial fibrillation (AF). Valve replacement reverses these abnormalities and regains normal atrial function, a behaviour which is directly related to the severity of pre-operative LV outflow tract obstruction. Early identification of LA size and function disturbances, as shown by myocardial strain measurements might contribute to better patient’s recruitment for a safe valve replacement.

In late stage HF patients, the right ventricle is enlarged, with reduced systolic function due to significant myocardial fibrosis. RV free wall myocardial deformation is the most accurate function measure that correlates with the extent of RV myocardial fibrosis and functional capacity.

In patients with preserved EF, severe MR masks LV and LA myocardial dysfunction and correlates with symptoms and post-operative cavity function instability. Three months after MVR, the underlying myocardial disturbances are unmasked suggesting that most pre-operative measurements are subject to loading conditions. Finally LA volume and PALS remain the main predictors of post-operative AF, thus should be used for stratifying surgical risk.

STE has been shown to accurately determine the severity of impairment of LA myocardial function shown by suppressed PALS which was the strongest predictor of the presence and extent of fibrosis, over and above other structure and function parameters. These findings may assist in better stratifying patients with end stage HF and identifying particularly those requiring HTx.

Place, publisher, year, edition, pages
Umeå: University of Umeå, 2016. 138 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1863
Keyword
Keywords Mitral regurgitation, aortic stenosis, speckle tracking echocardiography, heart transplantation, left atrial strain, left ventricualr function, right ventricular function, myocardial fibrosis
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-127294 (URN)978-91-7601-610-7 (ISBN)
Public defence
2016-12-01, Sal C, Unod T9, Norrlands Universitetssjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2016-11-10 Created: 2016-11-04 Last updated: 2016-11-21Bibliographically approved

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