Peak left atrial longitudinal strain is associated with all-cause mortality in patients with ventricular functional mitral regurgitation
Abstract Purpose Chronic 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...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-05-01
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| Series: | Cardiovascular Ultrasound |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12947-023-00307-7 |
| _version_ | 1797832217583419392 |
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| author | Daniel A. Gomes Pedro M. Lopes Pedro Freitas Francisco Albuquerque Carla Reis Sara Guerreiro João Abecasis Marisa Trabulo António M. Ferreira Jorge Ferreira Regina Ribeiras Miguel Mendes Maria J. Andrade |
| author_facet | Daniel A. Gomes Pedro M. Lopes Pedro Freitas Francisco Albuquerque Carla Reis Sara Guerreiro João Abecasis Marisa Trabulo António M. Ferreira Jorge Ferreira Regina Ribeiras Miguel Mendes Maria J. Andrade |
| author_sort | Daniel A. Gomes |
| collection | DOAJ |
| description | Abstract Purpose Chronic 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). Methods Patients 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. Results A 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. Conclusion PALS is independently associated with all-cause mortality in patients with reduced LVEF and ventricular FMR. Graphical Abstract |
| first_indexed | 2024-04-09T14:04:16Z |
| format | Article |
| id | doaj.art-5132a164a17142a08ed9260c17e21317 |
| institution | Directory Open Access Journal |
| issn | 1476-7120 |
| language | English |
| last_indexed | 2024-04-09T14:04:16Z |
| publishDate | 2023-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Cardiovascular Ultrasound |
| spelling | doaj.art-5132a164a17142a08ed9260c17e213172023-05-07T11:07:04ZengBMCCardiovascular Ultrasound1476-71202023-05-0121111010.1186/s12947-023-00307-7Peak left atrial longitudinal strain is associated with all-cause mortality in patients with ventricular functional mitral regurgitationDaniel A. Gomes0Pedro M. Lopes1Pedro Freitas2Francisco Albuquerque3Carla Reis4Sara Guerreiro5João Abecasis6Marisa Trabulo7António M. Ferreira8Jorge Ferreira9Regina Ribeiras10Miguel Mendes11Maria J. Andrade12Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa OcidentalDepartment of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa OcidentalDepartment of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa OcidentalDepartment of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa OcidentalDepartment of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa OcidentalDepartment of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa OcidentalDepartment of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa OcidentalDepartment of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa OcidentalDepartment of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa OcidentalDepartment of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa OcidentalDepartment of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa OcidentalDepartment of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa OcidentalDepartment of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa OcidentalAbstract Purpose Chronic 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). Methods Patients 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. Results A 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. Conclusion PALS is independently associated with all-cause mortality in patients with reduced LVEF and ventricular FMR. Graphical Abstracthttps://doi.org/10.1186/s12947-023-00307-7Functional mitral regurgitationPeak atrial longitudinal strainEchocardiographyHeart failurePrognosis |
| spellingShingle | Daniel A. Gomes Pedro M. Lopes Pedro Freitas Francisco Albuquerque Carla Reis Sara Guerreiro João Abecasis Marisa Trabulo António M. Ferreira Jorge Ferreira Regina Ribeiras Miguel Mendes Maria J. Andrade Peak left atrial longitudinal strain is associated with all-cause mortality in patients with ventricular functional mitral regurgitation Cardiovascular Ultrasound Functional mitral regurgitation Peak atrial longitudinal strain Echocardiography Heart failure Prognosis |
| title | Peak left atrial longitudinal strain is associated with all-cause mortality in patients with ventricular functional mitral regurgitation |
| title_full | Peak left atrial longitudinal strain is associated with all-cause mortality in patients with ventricular functional mitral regurgitation |
| title_fullStr | Peak left atrial longitudinal strain is associated with all-cause mortality in patients with ventricular functional mitral regurgitation |
| title_full_unstemmed | Peak left atrial longitudinal strain is associated with all-cause mortality in patients with ventricular functional mitral regurgitation |
| title_short | Peak left atrial longitudinal strain is associated with all-cause mortality in patients with ventricular functional mitral regurgitation |
| title_sort | peak left atrial longitudinal strain is associated with all cause mortality in patients with ventricular functional mitral regurgitation |
| topic | Functional mitral regurgitation Peak atrial longitudinal strain Echocardiography Heart failure Prognosis |
| url | https://doi.org/10.1186/s12947-023-00307-7 |
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