Time course of left atrial reverse remodelling after mitral valve surgery and the impact of left ventricular global longitudinal strain in patients with chronic severe mitral regurgitation.
We aimed to investigate the time course of left atrial (LA) reverse remodelling (LARR) after mitral valve (MV) surgery in patients with chronic severe mitral regurgitation (MR) and examine the impact of left ventricular (LV) mechanical function on LARR.



A total of 140 patients (73 males, age 54 ± 16 years) with chronic severe MR undergoing MV surgery were analysed. All patients underwent two-dimensional, Doppler and speckle-tracking echocardiography before and after surgery (1 week, 6 months and 12 months).



There was a significant decrease in LA volume from 137.8 ± 85.5 to 89.7 ± 54.6 ml (-32.1 ± 16.7%, P < 0.001) at 1 week after surgery. LA volume further decreased to 77.4 ± 52.4 ml (-9.9 ± 13.4%, P < 0.001) at 6 months but increased to 79.7 ± 62.4 ml (3.6 ± 11.9%, P = 0.002) at 12 months after surgery. Patients with good LARR (a reduction of ≥25% in LA volume) showed lower LV global longitudinal strain (LV-GLS) than those with poor LARR (P = 0.032). In simple correlation, age (r = 0.19, P = 0.026), preoperative LA volume (r = -0.28, P = 0.001) and preoperative LV-GLS (r = 0.28, P = 0.001) showed significant correlations with the % change in LA volume, whereas no correlations were observed with preoperative LV ejection fraction, global circumferential and radial strain. In multivariate analyses, preoperative LV-GLS (β = 0.24, P = 0.014) was an independent determinant for early LARR along with age and preoperative LA volume.



The majority of LARR after MV surgery occurred during the early postoperative period. LV-GLS, age and LA volume at surgery determined the degree of early LARR after MV surgery in patients with chronic severe MR.
Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Peter
P
Chipeta
Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea cysprs@yuhs.ac.
Chi Young
CY
Shim
Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Geu-Ru
GR
Hong
Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Darae
D
Kim
Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
In Jeong
IJ
Cho
Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Sak
S
Lee
Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Hyuck-Jae
HJ
Chang
Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Byung-Chul
BC
Chang
Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Jong-Won
JW
Ha
Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Namsik
N
Chung
D000368:Aged; D064752:Atrial Remodeling / Q000502:physiology*; D006348:Cardiac Surgical Procedures; D002908:Chronic Disease; D015150:Echocardiography, Doppler; D005260:Female; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D015999:Multivariate Analysis; D013997:Time Factors
Left atrium; Left ventricular strain; Mitral valve surgery; Reverse remodelling