Abstract
Volume overload in chronic severe mitral regurgitation (MR) causes left atrial (LA) remodeling. Volume overload generally diminishes after mitral valve surgery and LA size and shape are expected to recover. The recovery of LA functions named as reverse remodeling is said to be related with prognosis and mortality. A few clinical and echocardiographic parameters have been reported to be associated with LA reverse remodeling. In this study, we investigated the relationship between LA peak longitudinal strain (reservoir strain) assessed with 2-dimensional speckle tracking echocardiography (2D STE) and LA reverse remodeling. 53 patients (24 females and 29 males, mean age: 45.7 ± 13.5 years) with severe MR and preserved left ventricular systolic function were included in the study. All patients had normal sinus rhythm. The etiology of MR was mitral valve prolapse (MVP) in 37 patients and rheumatic valvular disease in 16 patients. Mitral valve repair was performed in 30 patients while 23 underwent mitral valve replacement. Echocardiography was performed before the surgery and 6 months later. LA peak atrial longitudinal strain (PALS) was assessed with speckle tracking imaging. LA reverse remodeling was defined as a percent of decrease in LA volume index (LAVI). Left atrial volume index significantly decreased after surgery (58.2 ± 16.6 vs. 43.9 ± 17.2 ml/m2, p ≤ 0.001). Mean LAVI reduction was 22.5 ± 27.2 %. There was no significant difference in LAVI reduction between mitral repair and replacement groups (22.1 ± 22.6 vs. 23.1 ± 32.8 %, p = 0.9). Although the decrease in LAVI was higher in MVP group than rheumatic group, it was not statistically significant (24.4 ± 26.8 vs. 18.2 ± 28.9 %, p = 0.4). Correlates of LAVI reduction were preoperative LAVI (r 0.28, p = 0.039), PALS (r 0.36, p = 0.001) and age (r −0.36, p = 0.007). Furthermore, in multivariate linear regression analysis (entering models), preoperative LAVI, age and PALS were all significant predictors of LA reverse remodeling (p ≤ 0.001, p = 0.04, p = 0.001 respectively). Left atrial peak longitudinal strain measured by 2D STE, in conjunction with preoperative LAVI and age is a predictor of LA reverse remodeling in patients undergoing surgery for severe MR. We suggest that in this patient population, PALS may also be used as a preoperative prognostic marker.
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Abbreviations
- EF:
-
Ejection fraction
- LA:
-
Left atrium
- LAVI:
-
Left atrial volume index
- LV:
-
Left ventricle
- PALS:
-
Peak atrial longitudinal strain
- PACS:
-
Peak atrial contraction strain
- MVP:
-
Mitral valve prolapse
- MVR:
-
Mitral valve replacement
- TVR:
-
Tricuspid valve repair
- PISA:
-
Proximal isovelocity surface area
- STE:
-
Speckle tracking echocardiography
- ASE:
-
American Society of Echocardiography
- MRI:
-
Magnetic resonance imaging
- BNP:
-
Brain natriuretic peptide
- MR:
-
Mitral regurgitation
References
Anne W, Willems R, Roskams T et al (2005) Matrix metalloproteinases and atrial remodeling in patients with mitral valve disease and atrial fibrillation. Cardiovasc Res 67:655–666
Verheule S, Wilson E, Everett T et al (2003) Alterations in atrial electrophysiology and tissue structure in a canine model of chronic atrial dilatation due to mitral regurgitation. Circulation 107:2615–2622
Benjamin EJ, D’Agostino RB, Belanger AJ et al (1995) Left atrial size and the risk of stroke and death. The Framingham Heart Study. Circulation 92:835–841
Tsang TS, Barnes ME, Bailey KR et al (2001) Left atrial volume: important risk marker of incident atrial fibrillation in 1655 older men and women. Mayo Clin Proc 76:467–475
Barnes ME, Miyasaka Y, Seward JB et al (2004) Left atrial volume in the prediction of first ischemic stroke in an elderly cohort without atrial fibrillation. Mayo Clin Proc 79:1008–1014
Moller JE, Hillis GS, Oh JK et al (2003) Left atrial volume: a powerful predictor of survival after acute myocardial infarction. Circulation 107:2207–2212
Pritchett AM, Jacobsen SJ, Mahoney DW et al (2003) Left atrial volume as an index of left atrial size: a population-based study. J Am Coll Cardiol 41:1036–1043
Lester SJ, Ryan EW, Schiller NB et al (1999) Best method in clinical practice and in research studies to determine left atrial size. Am J Cardiol 84:829–832
Rodevan O, Bjornerheim R, Ljosland M et al (1999) Left atrial volumes assessed by three- and two-dimensional echocardiography compared to MRI estimates. Int J Card Imaging 15:397–410
Vianna-Pinton R, Moreno CA, Baxter CM et al (2009) Two dimensional speckle-tracking echocardiography of the left atrium: feasibility and regional contraction and relaxation differences in normal subjects. J Am Soc Echocardiogr 22:299–305
Saraiva RM, Demirkol S, Buakhamsri A et al (2010) Left atrial strain measured by two-dimensional speckle tracking represents a new tool to evaluate left atrial function. J Am Soc Echocardiogr 23:172–180
Cameli M, Caputo M, Mondillo S et al (2009) Feasibility and reference values of left atrial longitudinal strain imaging by two-dimensional speckle tracking. Cardiovasc Ultrasound 7:6
Karabay CY, Zehir R, Güler A et al (2013) Left atrial deformation parameters predict left atrial appendage function and thrombus in patients in sinus rhythm with suspected cardioembolic stroke: a speckle tracking and transesophageal echocardiography study. Echocardiography 30(5):572–581
Candan O, Ozdemir N, Aung SM et al (2013) Left atrial longitudinal strain parameters predict postoperative persistent atrial fibrillation following mitral valve surgery: a speckle tracking echocardiography study. Echocardiography 30(9):1061–1068
Cameli M, Lisi M, Righini FM et al (2013) 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 111(4):595–601
Antonini-Canterin F, Beladan CC, Popescu BA et al (2008) Left atrial remodelling early after mitral valve repair for degenerative mitral regurgitation. Heart 94:759–764
Zoghbi WA, Enriquez-Sarano M, Foster E et al (2003) Recommendations for evaluation of the severity of native valvular regurgitation with two dimensional and Doppler echocardiography. J Am Soc Echocardiogr 16:777–802
Lang RM, Bierig M, Devereux RB et al (2006) Recommendations for chamber quantification: a report from the American Society of Echocardiography’s guidelines and Standards Committee and the Chamber Quantification Writing Group. J Am Soc Echocardiogr 35:363–369
Schabelman S, Schiller NB, Silverman NH et al (1981) Left atrial volume estimation by two-dimensional echocardiography. Catheter Cardiovasc Diagn 7:165–178
Schiller NB, Botvinick EH (1986) Noninvasive quantitation of the left heart by echocardiography and scintigraphy. Cardiovasc Clin 17:45–93
Pepi M, Tamborini G, Galli C et al (1994) A new formula for Echo–Doppler estimation of right ventricular systolic pressure. J Am Soc Echocardiogr 7:20–26
Braunwald E, Awe WC (1963) The syndrome of severe mitral regurgitation with normal left atrial pressure. Circulation 27:29–35
Kernis SJ, Nkomo VT, Messika-Zeitoun D et al (2004) Atrial fibrillation after surgical correction of mitral regurgitation in sinus rhythm: incidence, outcome, and determinants. Circulation 110:2320–2325
Tourneau TL, Messika-Zeitoun D, Russo A et al (2010) Impact of left atrial volume on clinical outcome in organic mitral regurgitation. J Am Coll Cardiol 56:570–578
Messika-Zeitoun D, Bellamy M, Avierinos JF et al (2007) Left atrial remodelling in mitral regurgitation-methodologic approach, physiological determinants, and outcome implications: a prospective quantitative Doppler-echocardiographic and electron beam-computed tomographic study. Eur Heart J 28(14):1773–1781
Bitigen A, Bulut M, Tanalp AC, Kirma C, Barutçu I, Pala S, Erkol A, Boztosun B (2007) Left atrial appendage functions in patients with severe rheumatic mitral regurgitation. Int J Cardiovasc Imaging 23(6):693–700
Bitigen A, Türkmen M, Karakaya O, Saglam M, Barutcu I, Esen AM, Türkyilmaz E, Erkol A, Bulut M, Boztosun B, Kirma C (2006) Early effects of percutaneous mitral valvuloplasty on left atrial mechanical functions. Tohoku J Exp Med 209:285–289
Tops LF, Delgado V, Bertini M et al (2011) Left atrial strain predicts reverse remodeling after catheter ablation for atrial fibrillation. J Am Coll Cardiol 57(3):324–331
Kim KH, Kim YJ, Shin DH et al (2010) Left atrial remodelling in patients with successful percutaneous mitral valvuloplasty: determinants and impact on long-term clinical outcome. Heart 96(13):1050–1055
Cho DK, Ha JW, Chang BC et al (2008) Factors determining early left atrial reverse remodeling after mitral valve surgery. Am J Cardiol 101(3):374–377
Marsan NA, Maffessanti F, Tamborini G et al (2011) Left atrial reverse remodeling and functional improvement after mitral valve repair in degenerative mitral regurgitation: a real-time 3-dimensional echocardiography study. Am Heart J 161(2):314–321
Song BG, On YK, Jeon ES et al (2010) Atrioventricular reverse remodeling after valve repair for chronic severe mitral regurgitation: 1-year follow-up. Clin Cardiol 33(10):630–637
Hyllén S, Nozohoor S, Meurling C et al (2013) Determinants of left atrial reverse remodeling after valve surgery for degenerative mitral regurgitation. J Heart Valve Dis 22(1):2–10
Borg AN, Harrison JL, Argyle RA, Pearce KA, Beynon R, Ray SG (2010) Left ventricular filling and diastolic myocardial deformation in chronic primary mitral regurgitation. Eur J Echocardiogr 11:523–529
Rossi A, Cicoira M, Golia G, Anselmi M, Zardini P (2001) Mitral regurgitation and left ventricular diastolic dysfunction similarly affect mitral and pulmonary vein flow Doppler parameters: the advantage of end-diastolic markers. J Am Soc Echocardiogr 14:562–568
Ohte N, Narita H, Akita S, Kurokawa K, Hayano J, Kimura G (2002) Striking effect of left ventricular high filling pressure with mitral regurgitation on mitral annular velocity during early diastole. A study using colour M-mode tissue Doppler imaging. Eur J Echocardiogr 3:52–58
Diwan A, McCulloch M, Lawrie GM, Reardon MJ, Nagueh SF (2005) Doppler estimation of left ventricular filling pressures in patients with mitral valve disease. Circulation 111:3281–3289
Kuppahally SS, Akoum N, Burgon NS et al (2010) Left atrial strain and strain rate in patients with paroxysmal and persistent atrial fibrillation: relationship to left atrial structural remodeling detected by delayed-enhancement MRI. Circ Cardiovasc Imaging 3(3):231–239
Cameli M, Lisi M, Giacomin E et al (2011) Chronic mitral regurgitation: left atrial deformation analysis by two-dimensional speckle tracking echocardiography. Echocardiography 28(3):327–334
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Candan, O., Ozdemir, N., Aung, S.M. et al. Atrial longitudinal strain parameters predict left atrial reverse remodeling after mitral valve surgery: a speckle tracking echocardiography study. Int J Cardiovasc Imaging 30, 1049–1056 (2014). https://doi.org/10.1007/s10554-014-0433-9
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DOI: https://doi.org/10.1007/s10554-014-0433-9