Peak left atrial longitudinal strain is associated with all-cause mortality in patients with ventricular functional mitral regurgitation

Cardiovascular Ultrasound

Research

João Abecasis¹  Regina Ribeiras¹  Pedro Freitas¹  Pedro M. Lopes¹  Jorge Ferreira¹  Marisa Trabulo¹  Maria J. Andrade¹  Carla Reis¹  Daniel A. Gomes¹  Miguel Mendes¹  António M. Ferreira¹  Francisco Albuquerque¹  Sara Guerreiro¹ 

[1] Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Av. Prof. Dr. Reinaldo Dos Santos, 2790-134, Carnaxide, Lisbon, Portugal;

关键词: Functional mitral regurgitation;    Peak atrial longitudinal strain;    Echocardiography;    Heart failure;    Prognosis;   

DOI  :  10.1186/s12947-023-00307-7

 received in 2022-12-15, accepted in 2023-04-28,  发布年份 2023

来源: Springer

【 摘 要 】

PurposeChronic mitral regurgitation promotes left atrial (LA) remodeling. However, the significance of LA dysfunction in the setting of ventricular functional mitral regurgitation (FMR) has not been fully investigated. Our aim was to assess the prognostic impact of peak atrial longitudinal strain (PALS), a surrogate of LA function, in patients with FMR and reduced left ventricular ejection fraction (LVEF).MethodsPatients with at least mild ventricular FMR and LVEF < 50% under optimized medical therapy who underwent transthoracic echocardiography at a single center were retrospectively identified in the laboratory database. PALS was assessed by 2D speckle tracking in the apical 4-chamber view and the study population was divided in two groups according to the best cut-off value of PALS, using receiver operating characteristics (ROC) curve analysis. The primary endpoint-point was all-cause mortality.ResultsA total of 307 patients (median age 70 years, 77% male) were included. Median LVEF was 35% (IQR: 27 – 40%) and median effective regurgitant orifice area (EROA) was 15mm2 (IQR: 9 – 22mm2). According to current European guidelines, 32 patients had severe FMR (10%). During a median follow-up of 3.5 years (IQR 1.4 – 6.6), 148 patients died. The unadjusted mortality incidence per 100 persons-years increased with progressively lower values of PALS. On multivariable analysis, PALS remained independently associated with all-cause mortality (adjusted hazard ratio 1.052 per % decrease; 95% CI: 1.010 – 1.095; P = 0.016), even after adjustment for several (n = 14) clinical and echocardiographic confounders.ConclusionPALS is independently associated with all-cause mortality in patients with reduced LVEF and ventricular FMR.Graphical Abstract

【 授权许可】

CC BY   
© The Author(s) 2023

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