title: 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.
abstract: 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.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Philippe
authors.initials: P
authors.lastname: Debonnaire
authors.forename: Darryl P
authors.initials: DP
authors.lastname: Leong
authors.forename: Tomasz G
authors.initials: TG
authors.lastname: Witkowski
authors.forename: Ibtihal
authors.initials: I
authors.lastname: Al Amri
authors.forename: Emer
authors.initials: E
authors.lastname: Joyce
authors.forename: Spyridon
authors.initials: S
authors.lastname: Katsanos
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Schalij
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Victoria
authors.initials: V
authors.lastname: Delgado
authors.forename: Nina Ajmone
authors.initials: NA
authors.lastname: Marsan
mesh_terms: D000368:Aged; D016279:Atrial Function, Left / Q000502:physiology*; D004452:Echocardiography / Q000379:methods*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D009200:Myocardial Contraction / Q000502:physiology; D015588:Observer Variation; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D011379:Prognosis; D012016:Reference Values; D015996:Survival Rate
keywords: 2D; Atrium; CI; Confidence interval; LA; LAVI; LV; LVEF; Left atrial; Left atrial volume indexed to body surface area; Left ventricular; Left ventricular ejection fraction; MR; Mitral regurgitation; Mitral valve; OR; Odds ratio; Regurgitation; Strain; Surgery; Two-dimensional