Abstract 11513: Assessment of Left Atrial Function By 2D-Speckle Tracking Echocardiography in Patients With Severe Organic Mitral Regurgitation: Association With Surgical Indication

Abstract

Introduction: The effect of chronic severe mitral regurgitation (MR) on left atrial (LA) function and clinical implications are largely unexplored.

Hypothesis: Patients with chronic severe organic MR may have LA dysfunction which may relate to indications for mitral surgery in these patients.

Methods: 2D-speckle tracking strain indices of LA reservoir, conduit and contractile function were assessed in 121 patients with chronic severe organic MR. Patients were further divided according to the presence of guidelines-based criteria for surgical indication (symptoms, left ventricular (LV) ejection fraction ≤60%, LV end-systolic diameter ≥40mm, atrial fibrillation or systolic pulmonary arterial pressure >50mmHg).

Results: Forty-six patients did not have any criterion for mitral surgery, whereas 75 patients had ≥1. LA reservoir (19 ± 7.7% vs 27 ± 6.6%, p<0.001), conduit (13 ± 4.7 % vs 17 ± 4.7%, p<0.001) and contractile (8 ± 3.4 % vs 10 ± 3.5%, p=0.03) functions were significantly impaired in patients with mitral surgery indication versus patients without. LA reservoir strain had the highest accuracy to identify patients with indication for mitral surgery (area under the ROC curve 0.8, 95%CI 0.72-0.87). On multivariate analysis, LA reservoir strain was independently associated with indication for mitral surgery (OR 0.88, 95%CI 0.82-0.94, p<0.001), providing incremental predictive value over important clinical and echocardiographic variables on likelihood ratio test. (Figure)

Conclusion: Patients with severe organic MR and indication for mitral surgery are characterized by impaired LA reservoir, conduit and contractile functions. LA reservoir strain is highly associated with the presence of guidelines-based criteria for mitral surgery indication and may therefore be used as a surrogate measure for follow-up and clinical decision-making in these patients.