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Peak left atrial longitudinal strain is associated with all-cause mortality in patients with ventricular functional mitral regurgitation
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...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10163691/ https://www.ncbi.nlm.nih.gov/pubmed/37147693 http://dx.doi.org/10.1186/s12947-023-00307-7 |
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author | Gomes, Daniel A. Lopes, Pedro M. Freitas, Pedro Albuquerque, Francisco Reis, Carla Guerreiro, Sara Abecasis, João Trabulo, Marisa Ferreira, António M. Ferreira, Jorge Ribeiras, Regina Mendes, Miguel Andrade, Maria J. |
author_facet | Gomes, Daniel A. Lopes, Pedro M. Freitas, Pedro Albuquerque, Francisco Reis, Carla Guerreiro, Sara Abecasis, João Trabulo, Marisa Ferreira, António M. Ferreira, Jorge Ribeiras, Regina Mendes, Miguel Andrade, Maria J. |
author_sort | Gomes, Daniel A. |
collection | PubMed |
description | 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 15mm(2) (IQR: 9 – 22mm(2)). 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: [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12947-023-00307-7. |
format | Online Article Text |
id | pubmed-10163691 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-101636912023-05-07 Peak left atrial longitudinal strain is associated with all-cause mortality in patients with ventricular functional mitral regurgitation Gomes, Daniel A. Lopes, Pedro M. Freitas, Pedro Albuquerque, Francisco Reis, Carla Guerreiro, Sara Abecasis, João Trabulo, Marisa Ferreira, António M. Ferreira, Jorge Ribeiras, Regina Mendes, Miguel Andrade, Maria J. Cardiovasc Ultrasound Research 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 15mm(2) (IQR: 9 – 22mm(2)). 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: [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12947-023-00307-7. BioMed Central 2023-05-06 /pmc/articles/PMC10163691/ /pubmed/37147693 http://dx.doi.org/10.1186/s12947-023-00307-7 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Gomes, Daniel A. Lopes, Pedro M. Freitas, Pedro Albuquerque, Francisco Reis, Carla Guerreiro, Sara Abecasis, João Trabulo, Marisa Ferreira, António M. Ferreira, Jorge Ribeiras, Regina Mendes, Miguel Andrade, Maria J. Peak left atrial longitudinal strain is associated with all-cause mortality in patients with ventricular functional mitral regurgitation |
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 | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10163691/ https://www.ncbi.nlm.nih.gov/pubmed/37147693 http://dx.doi.org/10.1186/s12947-023-00307-7 |
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