Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
권호 표지
DOI QR코드

DOI QR Code

Prognostic Impact of Left Atrial Strain After Mitral Valve Repair Surgery in Patients With Severe Mitral Regurgitation

  • Jin Kyung Oh (Division of Cardiology, Department of Internal Medicine, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine) ;
  • Yong-Hoon Yoon (Division of Cardiology, Department of Internal Medicine, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine) ;
  • Jae-Hyung Roh (Division of Cardiology, Department of Internal Medicine, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine) ;
  • Minsu Kim (Division of Cardiology, Department of Internal Medicine, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine) ;
  • Byung Joo Sun (Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine) ;
  • Sung-Ho Jung (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jae Hwan Lee (Division of Cardiology, Department of Internal Medicine, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine) ;
  • Jae Won Lee (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Dae-Hee Kim (Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jae-Hyeong Park (Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine)
  • Received : 2021.05.27
  • Accepted : 2021.11.10
  • Published : 2022.03.01
Download PDF
⟨ Previous Next ⟩

Abstract

Background and Objectives: The prognostic value of left atrial (LA) function in terms of long-term clinical outcomes after mitral regurgitation (MR) surgery remains unclear. Therefore, we investigated the impact of preoperative LA global longitudinal strain (LAGLS) on the long-term postoperative clinical outcomes in chronic severe MR patients who underwent mitral valve (MV) repair surgery. Methods: From January 2012 to December 2017, we analyzed 338 patients (mean age, 51.9±12.5 years; 218 males [64.5%]) treated with MV repair surgery for severe MR. The primary outcome was cardiovascular events, defined as the composite of all-cause death, newly developed atrial fibrillation (AF), and re-hospitalization for cardiovascular causes. Results: During a median follow-up of 45 months (interquartile range, 26-65), 30 (8.9%) cardiovascular events, 5 (1.5%) all-cause death, 8 (2.4%) newly developed AF, and 26 (7.7%) re-hospitalizations occurred. On multivariable analysis, baseline LAGLS was an independent predictor of cardiovascular events (adjusted hazard ratio [HR], 0.91; 95% confidential interval [CI], 0.85-0.97; p=0.004) and re-hospitalization (adjusted HR, 0.93; 95% CI, 0.86-1.00; p=0.037). According to the optimal cutoff value of LAGLS, patients with low LAGLS (<23.6%) had a significantly higher risk of cardiovascular events (adjusted HR, 2.70; 95% CI, 1.04-7.00; p=0.041) than those with high LAGLS (≥23.6%). In a subgroup analysis, patients with high LAGLS had better clinical outcomes regardless of whether the patient had a LA volume index <60 mL/m2. Conclusions: In patients with chronic severe MR who received successful MV repair surgery, preoperative LAGLS is an independent predictor of long-term postoperative outcomes.

Keywords

References

  1. Benjamin EJ, Virani SS, Callaway CW, et al. Heart disease and stroke statistics-2018 update: a report from the American Heart Association. Circulation 2018;137:e67-492. https://doi.org/10.1161/CIR.0000000000000573
  2. Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. Lancet 2006;368:1005-11. https://doi.org/10.1016/S0140-6736(06)69208-8
  3. Falk V, Baumgartner H, Bax JJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg 2017;52:616-64. https://doi.org/10.1093/ejcts/ezx324
  4. Cameli M, Lisi M, Giacomin E, et al. Chronic mitral regurgitation: left atrial deformation analysis by two-dimensional speckle tracking echocardiography. Echocardiography 2011;28:327-34. https://doi.org/10.1111/j.1540-8175.2010.01329.x
  5. Borg AN, Pearce KA, Williams SG, Ray SG. Left atrial function and deformation in chronic primary mitral regurgitation. Eur J Echocardiogr 2009;10:833-40. https://doi.org/10.1093/ejechocard/jep085
  6. Benjamin EJ, D'Agostino RB, Belanger AJ, Wolf PA, Levy D. Left atrial size and the risk of stroke and death. The Framingham Heart Study. Circulation 1995;92:835-41. https://doi.org/10.1161/01.CIR.92.4.835
  7. Toprak C, Kahveci G, Kilicgedik A, et al. Left atrial remodeling in patients undergoing percutaneous mitral valve repair with the MitraClip system: an advanced echocardiography study. Echocardiography 2016;33:1504-11. https://doi.org/10.1111/echo.13288
  8. Cameli M, Lisi M, Righini FM, et al. Usefulness of atrial deformation analysis to predict left atrial fibrosis and endocardial thickness in patients undergoing mitral valve operations for severe mitral regurgitation secondary to mitral valve prolapse. Am J Cardiol 2013;111:595-601. https://doi.org/10.1016/j.amjcard.2012.10.049
  9. Melenovsky V, Hwang SJ, Redfield MM, Zakeri R, Lin G, Borlaug BA. Left atrial remodeling and function in advanced heart failure with preserved or reduced ejection fraction. Circ Heart Fail 2015;8:295-303. https://doi.org/10.1161/CIRCHEARTFAILURE.114.001667
  10. Park JH, Hwang IC, Park JJ, Park JB, Cho GY. Prognostic power of left atrial strain in patients with acute heart failure. Eur Heart J Cardiovasc Imaging 2021;22:210-9. https://doi.org/10.1093/ehjci/jeaa013
  11. Zoghbi WA, Adams D, Bonow RO, et al. Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr 2017;30:303-71. https://doi.org/10.1016/j.echo.2017.01.007
  12. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2015;16:233-70. https://doi.org/10.1093/ehjci/jev014
  13. Vianna-Pinton R, Moreno CA, Baxter CM, Lee KS, Tsang TS, Appleton CP. Two-dimensional speckle-tracking echocardiography of the left atrium: feasibility and regional contraction and relaxation differences in normal subjects. J Am Soc Echocardiogr 2009;22:299-305. https://doi.org/10.1016/j.echo.2008.12.017
  14. Nagueh SF, Smiseth OA, Appleton CP, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2016;29:277-314. https://doi.org/10.1016/j.echo.2016.01.011
  15. Nagueh SF, Middleton KJ, Kopelen HA, Zoghbi WA, Quinones MA. Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol 1997;30:1527-33. https://doi.org/10.1016/S0735-1097(97)00344-6
  16. Yock PG, Popp RL. Noninvasive estimation of right ventricular systolic pressure by Doppler ultrasound in patients with tricuspid regurgitation. Circulation 1984;70:657-62. https://doi.org/10.1161/01.CIR.70.4.657
  17. Brennan JM, Blair JE, Goonewardena S, et al. Reappraisal of the use of inferior vena cava for estimating right atrial pressure. J Am Soc Echocardiogr 2007;20:857-61. https://doi.org/10.1016/j.echo.2007.01.005
  18. Badano LP, Kolias TJ, Muraru D, et al. Standardization of left atrial, right ventricular, and right atrial deformation imaging using two-dimensional speckle tracking echocardiography: a consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging 2018;19:591-600. https://doi.org/10.1093/ehjci/jey042
  19. Mor-Avi V, Lang RM, Badano LP, et al. Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. J Am Soc Echocardiogr 2011;24:277-313. https://doi.org/10.1016/j.echo.2011.01.015
  20. Pathan F, D'Elia N, Nolan MT, Marwick TH, Negishi K. Normal ranges of left atrial strain by speckle-tracking echocardiography: a systematic review and meta-analysis. J Am Soc Echocardiogr 2017;30:59-70.e8. https://doi.org/10.1016/j.echo.2016.09.007
  21. Ho KK, Anderson KM, Kannel WB, Grossman W, Levy D. Survival after the onset of congestive heart failure in Framingham Heart Study subjects. Circulation 1993;88:107-15. https://doi.org/10.1161/01.CIR.88.1.107
  22. Pritchett AM, Jacobsen SJ, Mahoney DW, Rodeheffer RJ, Bailey KR, Redfield MM. Left atrial volume as an index of left atrial size: a population-based study. J Am Coll Cardiol 2003;41:1036-43. https://doi.org/10.1016/S0735-1097(02)02981-9
  23. Park JH, Kim KH, Rink L, et al. Left atrial enlargement and its association with left atrial strain in university athletes participated in 2015 Gwangju Summer Universiade. Eur Heart J Cardiovasc Imaging 2020;21:865-72. https://doi.org/10.1093/ehjci/jeaa084
  24. Facchini E, Degiovanni A, Marino PN. Left atrium function in patients with coronary artery disease. Curr Opin Cardiol 2014;29:423-9. https://doi.org/10.1097/HCO.0000000000000085
  25. Appleton CP, Kovacs SJ. The role of left atrial function in diastolic heart failure. Circ Cardiovasc Imaging 2009;2:6-9. https://doi.org/10.1161/CIRCIMAGING.108.845503
  26. Park JH. Two-dimensional echocardiographic assessment of myocardial strain: important echocardiographic parameter readily useful in clinical field. Korean Circ J 2019;49:908-31. https://doi.org/10.4070/kcj.2019.0200
  27. Cameli M, Pastore MC, Righini FM, et al. Prognostic value of left atrial strain in patients with moderate asymptomatic mitral regurgitation. Int J Cardiovasc Imaging 2019;35:1597-604. https://doi.org/10.1007/s10554-019-01598-6
  28. Debonnaire P, Leong DP, Witkowski TG, et al. Left atrial function by two-dimensional speckle-tracking echocardiography in patients with severe organic mitral regurgitation: association with guidelines-based surgical indication and postoperative (long-term) survival. J Am Soc Echocardiogr 2013;26:1053-62. https://doi.org/10.1016/j.echo.2013.05.019