Abstract 11443: Predictive Value of Left Atrial Deformation on Prognosis in Severe Primary Mitral Regurgitation
Background: Left atrial (LA) deformation parameters represented by strain and strain rate were decreased in severe primary mitral regurgitation (MR). However, the prognostic effects of these parameters were still unknown.
Methods: We recruited 115 (56.5% men, 57±16 years) consecutive patients with asymptomatic or mildly symptomatic (New York Heart Association functional classification I or II) severe primary MR and preserved left ventricular (LV) systolic function prospectively. LA deformation indexes including global peak LA longitudinal strain (LASp), peak strain rate in reservoir phase (LASRr), and in conduit phase (LASRc) were identified using the two-dimensional speckle tracking echocardiography.
Results: After a mean follow-up period of 8.4 ± 7.8 months, 30 (26%) patients reached the composite end-points (heart failure progression or admission, new atrial fibrillation (AF), stroke, mitral valve repair or replacement). Presence of AF (30 vs. 9.4 %; p = 0.006), LV end-systolic dimension (3.5 ± 0.5 vs. 3.3 ± 0.5 cm; p = 0.035), early trans-mitral velocity to tissue Doppler mitral annular early diastolic velocity ratio (E/e’) (13.4 ± 4.2 vs. 11.5 ± 3.8; p = 0.032), LASp (23.5 ±
9.2 vs. 27.8 ± 10.0 %; p = 0.078) and LASRc (-1.9 ± 0.6 vs. -2.3 ± 0.8
1/s; p = 0.058) were different between patients with and without end-points. After Cox regression analysis controlling AF status, only LASp (OR 0.94, 95%CI 0.890-0.994, p = 0.03) and LASRc (OR 2.236, 95%CI 1.033-4.842, p = 0.041) were independent factors for the occurrence of end-points. By dividing subjects into 2 groups with equal patient numbers (cutoff values LASp 25.4 % and LASRc -2.0 1/s), the Kaplan-Meier survival curves showed significant differences or a trend toward differences in terms of the composite endpoints.
Conclusion: Among patients with severe primary MR and insignificant symptoms, reduced LASp and increased LASRc were correlated with worse prognosis.
- © 2013 by American Heart Association, Inc.