title: Prognostic value of left atrial volume in asymptomatic organic mitral regurgitation.
abstract: BACKGROUND
  Basal left atrial volume (LAV) indexed to body surface area (LAVI) predicts adverse events in patients with organic mitral regurgitation, but information is lacking regarding change in left atrial volume during follow-up.
  
  
  METHODS
  One hundred forty-four asymptomatic patients (mean age, 71 ± 12 years; 66% women; mean ejection fraction, 66 ± 4.8%) with moderate to severe mitral regurgitation were prospectively included, with a median follow-up period of 2.76 years (interquartile range, 1.86-3.48 years).
  
  
  RESULTS
  Fifty-four patients (37.50%) reached the combined end point of dyspnea and/or systolic dysfunction. Both basal and change in LAV were independently associated with the combined end point on multivariate analysis: for basal LAVI ≥ 55 mL/m(2), odds ratio, 2.26 (95% confidence interval, 1.04-4.88; P = .038), and for change in LAV ≥ 14 mL, odds ratio, 7.32 (95% confidence interval, 3.25-16.48; P < .001), adjusted for effective regurgitant orifice area and deceleration time. Combined event-free survival at 1, 2, and 3 years was significantly less in patients with basal LAVI ≥ 55 mL/m(2) (75%, 58%, and 43%) than in those with basal LAVI < 55 mL/m(2) (95%, 89%, and 77%) (log-rank test = 15.38, P = .0001). The incidence of the combined end point was highest (88%) in patients with basal LAVI ≥ 55 mL/m(2) and change in LAV ≥ 14 mL.
  
  
  CONCLUSIONS
  Measurement of basal LAV and its increase during follow-up predict an adverse course in patients with moderate and severe asymptomatic mitral regurgitation. Hence, its assessment could be incorporated into the currently used algorithm for risk stratification and decision making in this group of patients.
authors.affiliation: Institute of Cardiovascular Medicine, Cardiology Division, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. anibal.arias@hospitalitaliano.org.ar
authors.forename: Aníbal
authors.initials: A
authors.lastname: Arias
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Pizarro
authors.forename: Pablo
authors.initials: P
authors.lastname: Oberti
authors.forename: Mariano
authors.initials: M
authors.lastname: Falconi
authors.forename: Luciano
authors.initials: L
authors.lastname: Lucas
authors.forename: Federico
authors.initials: F
authors.lastname: Sosa
authors.forename: Diego
authors.initials: D
authors.lastname: Funes
authors.forename: Arturo
authors.initials: A
authors.lastname: Cagide
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D015150:Echocardiography, Doppler / Q000379:methods*; D023381:Endpoint Determination; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D015996:Survival Rate; D016896:Treatment Outcome