title: Usefulness of atrial deformation analysis to predict left atrial fibrosis and endocardial thickness in patients undergoing mitral valve operations for severe mitral regurgitation secondary to mitral valve prolapse.
abstract: In patients with severe mitral regurgitation (MR) referred for cardiac surgery, left atrial (LA) remodeling and enlargement are accompanied by mechanical stress, mediated cellular hypertrophy, and interstitial fibrosis that finally lead to LA failure. Speckle tracking echocardiography is a novel non-Doppler-based method that allows an objective quantification of LA myocardial deformation, becoming useful for LA functional analysis. We conducted a study to evaluate the relation between the traditional and novel atrial indexes and the extent of ultrastructural alterations, obtained from patients with severe MR who were undergoing surgical correction of the valvular disease. The study population included 46 patients with severe MR, referred to our echocardiographic laboratory for a diagnostic examination before cardiac surgery. The global peak atrial longitudinal strain (PALS) was measured in all subjects by averaging all atrial segments. LA tissue samples were obtained from all patients. Masson's trichrome staining was performed to assess the extent of the fibrosis. The LA endocardial thickness was measured. A close negative correlation between the global PALS and grade of LA myocardial fibrosis was found (r = -0.82, p <0.0001), with poorer correlations for the LA indexed volume (r = 0.51, p = 0.01), LA ejection fraction (r = 0.61, p = 0.005), and E/E' ratio (0.14, p = NS). Of these indexes, global PALS showed the best diagnostic accuracy to detect LA fibrosis (area under the curve 0.89), and it appears to be a strong and independent predictor of LA fibrosis. Furthermore, we also demonstrated an inverse correlation between the global PALS and LA endocardial thickness (r = -0.66, p = 0.0001). In conclusion, in patients with severe MR referred for cardiac surgery, impairment of LA longitudinal deformation, as assessed by the global PALS, correlated strongly with the extent of LA fibrosis and remodeling.
authors.affiliation: Department of Cardiovascular Diseases, University of Siena, Siena, Italy. cameli@cheapnet.it
authors.forename: Matteo
authors.initials: M
authors.lastname: Cameli
authors.forename: Matteo
authors.initials: M
authors.lastname: Lisi
authors.forename: Francesca Maria
authors.initials: FM
authors.lastname: Righini
authors.forename: Alberto
authors.initials: A
authors.lastname: Massoni
authors.forename: Benedetta Maria
authors.initials: BM
authors.lastname: Natali
authors.forename: Marta
authors.initials: M
authors.lastname: Focardi
authors.forename: Damiana
authors.initials: D
authors.lastname: Tacchini
authors.forename: Alessia
authors.initials: A
authors.lastname: Geyer
authors.forename: Valeria
authors.initials: V
authors.lastname: Curci
authors.forename: Cristina
authors.initials: C
authors.lastname: Di Tommaso
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Lisi
authors.forename: Massimo
authors.initials: M
authors.lastname: Maccherini
authors.forename: Mario
authors.initials: M
authors.lastname: Chiavarelli
authors.forename: Massimo
authors.initials: M
authors.lastname: Massetti
authors.forename: Piero
authors.initials: P
authors.lastname: Tanganelli
authors.forename: Sergio
authors.initials: S
authors.lastname: Mondillo
mesh_terms: D000368:Aged; D016279:Atrial Function, Left; D006348:Cardiac Surgical Procedures; D015150:Echocardiography, Doppler / Q000379:methods / Q000706:statistics & numerical data*; D004699:Endocardium / Q000000981:diagnostic imaging*; D005260:Female; D005355:Fibrosis / Q000000981:diagnostic imaging; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D008945:Mitral Valve Prolapse / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D057234:Preoperative Period; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index