Early Improvement in Left Atrial Remodeling and Function after Mitral Valve Repair or Replacement in Organic Symptomatic Mitral Regurgitation Assessed by Three-Dimensional Echocardiography

Background Left atrial (LA) dilation is associated with worse prognosis in various clinical situations including chronic mitral regurgitation (MR). Real time three‐dimensional echocardiography (3DE) has allowed a better assessment of LA volumes and function. Little is known about LA size and functio...

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Published in:	Echocardiography (Mount Kisco, N.Y.) Vol. 32; no. 7; pp. 1122 - 1130
Main Authors:	Le Bihan, David C. S., Della Togna, Dorival Julio, Barretto, Rodrigo B. M., Assef, Jorge Eduardo, Machado, Lúcia Romero, Ramos, Auristela Isabel de Oliveira, Abdulmassih Neto, Camilo, Moisés, Valdir Ambrosio, Sousa, Amanda G. M. R., Campos, Orlando
Format:	Journal Article
Language:	English
Published:	United States Blackwell Publishing Ltd 01-07-2015
Subjects:	Adult Atrial Remodeling - physiology Echocardiography, Three-Dimensional Female Heart Atria - diagnostic imaging Heart Valve Prosthesis Implantation Humans left atrial function left atrial volume Male Middle Aged mitral regurgitation Mitral Valve - diagnostic imaging Mitral Valve - surgery Mitral Valve Insufficiency - diagnostic imaging Mitral Valve Insufficiency - surgery Prospective Studies three-dimensional echocardiography three-dimensional echocardiography left atrial volume mitral regurgitation left atrial function
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Summary:	Background Left atrial (LA) dilation is associated with worse prognosis in various clinical situations including chronic mitral regurgitation (MR). Real time three‐dimensional echocardiography (3DE) has allowed a better assessment of LA volumes and function. Little is known about LA size and function in early postoperative period in symptomatic patients with chronic organic MR. We aimed to investigate these aspects. Methods By means of 3DE, 43 patients with symptomatic chronic organic MR were prospectively studied before and 30 days after surgery (repair or bioprosthetic valve replacement). Twenty subjects were studied as controls. Maximum (Vol‐max), minimum, and preatrial contraction LA volumes were measured and total, passive, and active LA emptying fractions were calculated. Results Before surgery patients had higher LA volumes (P < 0.001) but smaller LA emptying fractions than controls (P < 0.01). After surgery there was a reduction in all 3 LA volumes and an increase in active atrial emptying fraction (AAEF). Multivariate analysis showed that independent predictors of early postoperative Vol‐max reduction were preoperative diastolic blood pressure (coefficient = −0.004; P = 0.02), lateral mitral annular early diastolic velocity (e′) (coefficient = 0.023; P = 0.008), and the mean transmitral diastolic gradient increment (coefficient = −0.035; P < 0.001). Furthermore, e′ was also independently associated with AAEF increase (odds ratio = 1.66, P = 0.027). Conclusion Early LA reverse remodeling and functional improvement occur after successful surgery of symptomatic organic MR regardless of surgical technique. Diastolic blood pressure and transmitral mean gradient augmentation are variables negatively related to Vol‐max reduction. Besides, e′ is positively correlated with both Vol‐max reduction and AAEF increase.
Bibliography:	ark:/67375/WNG-VZTJDPJR-T istex:C54FFF15A97736DFBE3C113EB1731057D4350EAF ArticleID:ECHO12817 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0742-2822 1540-8175
DOI:	10.1111/echo.12817