Predictive value of left atrial deformation on prognosis in severe primary mitral regurgitation.
BACKGROUND
Impaired left atrial (LA) deformation is noted in patients with severe primary mitral regurgitation (MR), but its prognostic value is unknown. The aim of this study was to investigate the prognostic significance of LA deformation parameters in patients with chronic severe primary MR.


METHODS
A total of 104 patients with asymptomatic chronic severe primary MR (Carpentier type II) and preserved left ventricular systolic function were prospectively recruited. Global peak positive strain of the left atrium (LASp) and strain rate in the LA filling phase (LASRr) as well as strain rate in the LA conduit phase were identified using two-dimensional speckle-tracking echocardiography.


RESULTS
During a mean follow-up period of 13.2 ± 9.5 months, 22 patients reached a composite end point of death and mitral valve repair or replacement prompted by heart failure development. Among the clinical and echocardiographic parameters, LV end-systolic volume index (19.5 ± 9.5 vs 15.7 ± 6.3 mL/m(2), P = .028), LASp (22.7 ± 10.4% vs 27.2 ± 9.1%, P = .049), and LASRr (1.97 ± 0.6 vs 2.33 ± 0.6 1/sec, P = .013) varied between the two groups in terms of end points but not age, LA volume index, left ventricular ejection fraction, pulmonary artery systolic pressure, and presence of atrial fibrillation. After multivariate analysis, low LASp (odds ratio, 3.606; 95% CI, 1.294-10.052; P = .014) and low LASRr (odds ratio, 2.857; 95% CI, 1.078-7.572; P = .035) remained powerful outcome indicators.


CONCLUSIONS
In patients with asymptomatic severe primary MR, reduced LASp and LASRr predicted a worse prognosis. These findings may offer additional information to guide early surgery.
Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Internal Medicine, Tainan Hospital, Tainan, Taiwan.
Li-Tan
LT
Yang
Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Yen-Wen
YW
Liu
Department of Internal Medicine, Chi-Mei Hospital, Tainan, Taiwan.
Jhih-Yuan
JY
Shih
Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Yi-Heng
YH
Li
Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Liang-Miin
LM
Tsai
Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Chwan-Yau
CY
Luo
Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan. Electronic address: wctsai@seed.net.tw.
Wei-Chuan
WC
Tsai
D004452:Echocardiography / Q000379:methods / Q000706:statistics & numerical data*; D054459:Elasticity Imaging Techniques / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000401:mortality*; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015996:Survival Rate; D013624:Taiwan / Q000453:epidemiology
Left atrium; Mitral regurgitation; Speckle-tracking echocardiography; Strain rate