Cited 36 times since 2013 (5.8 per year) source: Scopus Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography, Volume 26, Issue 9, 13 July 2013, Pages 1053-1062 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. Debonnaire P, Leong DP, Witkowski TG, Al Amri I, Joyce E, Katsanos S, Schalij MJ, Bax JJ, Delgado V, Marsan NA

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.

Keywords: Strain, Confidence interval, Ci, Surgery, Mitral valve, Mitral regurgitation, Atrium, LA, MR, Left ventricular ejection fraction, Regurgitation, Odds Ratio, Left Ventricular, Lv, 2d, Lvef, Or, Two-dimensional, Lavi, Left Atrial, Left Atrial Volume Indexed To Body Surface Area

J Am Soc Echocardiogr. 2013 Jul;26(9):1053-1062