The association of left atrial volume with exercise capacity in patients with chronic severe mitral regurgitation.
BACKGROUND
Left atrial volume and exercise capacity are strong predictors of cardiovascular risk. Decreased exercise capacity is expected when LAV is increased due to its association with abnormal left ventricular filling pressure. However, LAV enlargement is expected in chronic mitral regurgitation as well.


OBJECTIVE
To examine the link between LAV and exercise capacity in chronic MR and to determine whether larger LAV has indeed better exercise capacity in patients with chronic severe degenerative MR and good LV systolic function.


METHODS
The study included asymptomatic patients with severe chronic degenerative MR and normal LV systolic function that underwent stress echocardiography. LAV was measured at rest using the biplane Simpson's method and indexed to body surface area. The cutoff of good exercise capacity was determined at 7 METS.


RESULTS
The patient group comprised 52 consecutive patients (age 60 +/- 14 years, 36 males). Two subgroups (19 vs. 33 patients), age- and gender-matched, were formed according to LAVi cutoff of 42 ml/m2. Those with higher LAVi had lower exercise capacity (P = 0.004) albeit similar MR grade, baseline blood pressure, LV function and size. Receiver-operator curve analysis revealed indexed LAV value of < or = 42 as 51% sensitive and 88% specific for predicting exercise capacity > 7 METS (AUC = 0.7, P = 0.03). In multivariate analysis, age, gender and LAVi were identified as independent predictors of exercise capacity.


CONCLUSIONS
In asymptomatic patients with severe chronic degenerative MR and normal LV systolic function, mild enlargement of the left atrium (< or = 42 ml/m2) is associated with good exercise capacity.
Vaturi
Mordehay
M
Echocardiography Unit and Valvular Clinic, Department of Cardiology, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel. mvaturi@clalit.org.il
Hadar
Tanya
T
Yedidya
Idit
I
Shapira
Yaron
Y
Monakier
Daniel
D
Weisenberg
Daniel E
DE
Sagie
Alex
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology; D001830:Body Surface Area; D006332:Cardiomegaly / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016022:Case-Control Studies; D002908:Chronic Disease; D015331:Cohort Studies; D025401:Echocardiography, Stress; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology*; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013599:Systole / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology; D017725:Ventricular Pressure / Q000502:physiology