title: Early improvement in left atrial remodeling and function after mitral valve repair or replacement in organic symptomatic mitral regurgitation assessed by three-dimensional echocardiography.
abstract: BACKGROUND
  Left atrial (LA) dilation is associated with worse prognosis in various clinical situations including chronic mitral regurgitation (MR). Real time three-dimensional echocardiography (3DE) has allowed a better assessment of LA volumes and function. Little is known about LA size and function in early postoperative period in symptomatic patients with chronic organic MR. We aimed to investigate these aspects.
  
  
  METHODS
  By means of 3DE, 43 patients with symptomatic chronic organic MR were prospectively studied before and 30 days after surgery (repair or bioprosthetic valve replacement). Twenty subjects were studied as controls. Maximum (Vol-max), minimum, and preatrial contraction LA volumes were measured and total, passive, and active LA emptying fractions were calculated.
  
  
  RESULTS
  Before surgery patients had higher LA volumes (P < 0.001) but smaller LA emptying fractions than controls (P < 0.01). After surgery there was a reduction in all 3 LA volumes and an increase in active atrial emptying fraction (AAEF). Multivariate analysis showed that independent predictors of early postoperative Vol-max reduction were preoperative diastolic blood pressure (coefficient = -0.004; P = 0.02), lateral mitral annular early diastolic velocity (e') (coefficient = 0.023; P = 0.008), and the mean transmitral diastolic gradient increment (coefficient = -0.035; P < 0.001). Furthermore, e' was also independently associated with AAEF increase (odds ratio = 1.66, P = 0.027).
  
  
  CONCLUSIONS
  Early LA reverse remodeling and functional improvement occur after successful surgery of symptomatic organic MR regardless of surgical technique. Diastolic blood pressure and transmitral mean gradient augmentation are variables negatively related to Vol-max reduction. Besides, e' is positively correlated with both Vol-max reduction and AAEF increase.
authors.affiliation: Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil.|Escola Paulista de Medicina-Universidade Federal de Sao Paulo, Sao Paulo, Brazil.
authors.forename: David C S
authors.initials: DC
authors.lastname: Le Bihan
authors.affiliation: Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil.
authors.forename: Dorival Julio
authors.initials: DJ
authors.lastname: Della Togna
authors.affiliation: Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil.
authors.forename: Rodrigo B M
authors.initials: RB
authors.lastname: Barretto
authors.affiliation: Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil.
authors.forename: Jorge Eduardo
authors.initials: JE
authors.lastname: Assef
authors.affiliation: Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil.
authors.forename: Lúcia Romero
authors.initials: LR
authors.lastname: Machado
authors.affiliation: Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil.
authors.forename: Auristela Isabel de Oliveira
authors.initials: AI
authors.lastname: Ramos
authors.affiliation: Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil.
authors.forename: Camilo
authors.initials: C
authors.lastname: Abdulmassih Neto
authors.affiliation: Escola Paulista de Medicina-Universidade Federal de Sao Paulo, Sao Paulo, Brazil.
authors.forename: Valdir Ambrosio
authors.initials: VA
authors.lastname: Moisés
authors.affiliation: Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil.
authors.forename: Amanda G M R
authors.initials: AG
authors.lastname: Sousa
authors.affiliation: Escola Paulista de Medicina-Universidade Federal de Sao Paulo, Sao Paulo, Brazil.
authors.forename: Orlando
authors.initials: O
authors.lastname: Campos
mesh_terms: D000328:Adult; D064752:Atrial Remodeling / Q000502:physiology*; D019560:Echocardiography, Three-Dimensional; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000601:surgery*; D011446:Prospective Studies
keywords: left atrial function; left atrial volume; mitral regurgitation; three-dimensional echocardiography