Left Atrial Size Is a Potent Predictor of Mortality in Mitral Regurgitation Due to Flail Leaflets (original) (raw)

Left atrial size predicts outcome in severe but asymptomatic mitral regurgitation

Scientific Reports

Patients with severe asymptomatic primary mitral regurgitation (MR) can be safely managed with an active surveillance strategy. Left atrial (LA) size is affected by MR severity, left ventricular function and is also associated with the risk of atrial fibrillation and may be an integrative parameter for risk stratification. The present study sought to determine the predictive value of LA size in a large series of asymptomatic patients with severe MR. 280 consecutive patients (88 female, median age 58 years) with severe primary MR and no guideline-based indications for surgery were included in a follow-up program until criteria for mitral surgery were reached. Event-free survival was determined and potential predictors of outcome were assessed. Survival free of any indication for surgery was 78% at 2 years, 52% at 6 years, 35% at 10 years and 19% at 15 years, respectively. Left atrial (LA) diameter was the strongest independent echocardiographic predictor of event-free survival with i...

Association between early surgical intervention vs watchful waiting and outcomes for mitral regurgitation due to flail mitral valve leaflets

JAMA : the journal of the American Medical Association, 2013

IMPORTANCE The optimal management of severe mitral valve regurgitation in patients without class I triggers (heart failure symptoms or left ventricular dysfunction) remains controversial in part due to the poorly defined long-term consequences of current management strategies. In the absence of clinical trial data, analysis of large multicenter registries is critical. OBJECTIVE To ascertain the comparative effectiveness of initial medical management (nonsurgical observation) vs early mitral valve surgery following the diagnosis of mitral regurgitation due to flail leaflets.

Outcomes in Mitral Regurgitation Due to Flail Leaflets

JACC: Cardiovascular Imaging, 2008

on behalf of the MIDA Investigators Bologna and Modena, Italy; Amiens and Marseille, France; and Rochester, Minnesota O B J E C T I V E S The purpose of this study was to assess incidence and predictors of events associated with nonsurgical and surgical management of severe mitral regurgitation (MR) in European institutions. B A C K G R O U N D The management of patients with MR remains disputed, warranting multicenter studies to define clinical outcome in routine clinical practice. M E T H O D S The MIDA (Mitral Regurgitation International DAtabase) is a registry created for multicenter study of MR with echocardiographically diagnosed flail leaflet as a model of pure, organic

Impact of Left Atrial Volume on Clinical Outcome in Organic Mitral Regurgitation

Journal of the American College of Cardiology, 2010

p Ͻ 0.05 versus LA index Ͻ40 ml/m 2 ; †p Ͻ 0.0001 versus LA index Ͻ40 ml/m 2 ; ‡p Ͻ 0.05 versus LA index 40 to 59 ml/m 2 ; §p Ͻ 0.0001 versus LA index 40 to 59 ml/m 2 . BP ϭ blood pressure; BSA ϭ body surface area, DT ϭ deceleration time; EF ϭ ejection fraction; ERO ϭ effective regurgitant orifice; ESVI ϭ left ventricular end-systolic volumes indexed (normalized to body surface area); LA index ϭ left atrial volume indexed to body surface area; LVD ϭ left ventricular end-diastolic diameter; LV EDVI ϭ left ventricular end-diastolic volumes indexed (normalized to body surface area); LVS ϭ left ventricular end-systolic diameter; PASP ϭ pulmonary artery systolic pressure; RVol ϭ regurgitant volume.

Left Atrial Function Is Associated with Earlier Need for Cardiac Surgery in Moderate to Severe Mitral Regurgitation: Usefulness in Targeting for Early Surgery

Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography, 2018

The aim of this study was to determine whether assessment of left atrial (LA) function helps identify patients at risk for early deterioration during follow-up with mitral valve prolapse and mitral regurgitation. Patients with moderate to severe mitral regurgitation but no guideline-based indications for surgery were retrospectively identified from a dedicated clinical database. Maximal and minimal LA volumes were used to derive total LA emptying fraction ([maximal LA volume - minimal LA volume]/maximal L volume × 100%). Average values of peak contractile, conduit, and reservoir strain were obtained using two-dimensional speckle-tracking imaging. The study outcome was time to mitral surgery. One hundred seventeen patients were included; median follow-up was 18 months. Sixty-eight patients underwent surgery. Receiver operating characteristic curves were used to derive optimal cutoffs for TLAEF (>50.7%) and strain (reservoir, >28.5%; contractile, >12.5%). Using Cox analysis, ...

Mitral regurgitation severity correlates with symptoms and extent of left atrial dysfunction: Effect of mitral valve repair

Journal of Clinical Ultrasound, 2017

Purpose: We aimed to assess the relationship between mitral regurgitation (MR) severity, symptoms, and left atrial (LA) structure and function, before and after mitral valve repair (MVR). Methods: Global peak atrial longitudinal strain (PALS) was evaluated in 37 patients with severe symptomatic MR and preserved left ventricular (LV) ejection fraction (60.4% 6 4.6%) before and 3 months after MVR and was compared with values from 30 age-and gender-matched controls. Results: Before surgery, PALS was worse in patients than in controls and indexed LA volume was greater (P < .0001 for both). After MVR, PALS deteriorated further and LA volume decreased (P 5 .001 and P 5 .05, respectively) as did LV ejection fraction, longitudinal strain (P 5 .05 and

Long-term follow-up of mitral valve regurgitation—Importance of mitral valve pathology and left ventricular function on survival

International Journal of Cardiology, 2009

Timing of surgery for mitral regurgitation (MR) is one of the more difficult decisions for the practicing cardiologist. In order to determine useful clinical cut-offs, we investigated the influence of baseline echocardiographic predictors for survival in a long-time follow-up cohort. Data from 144 patients with MR were collected between 1989 and 1993. Five-year mortality for MR patients was 30% compared to 13% for age- and sex matched controls (p&amp;amp;amp;amp;lt;0.001). Each mm increase in left ventricular end systolic diameter (LVESD increased mortality with 2.5% (p&amp;amp;amp;amp;lt;0.05) and each percent decrease in ejection fraction (EF) increased mortality with 1.8% (p&amp;amp;amp;amp;lt;0.05). These effects were not linear and this material suggests cut-off points for LVESD to be 40 mm and EF 50%. Degree of MR did not correlate with survival, but patients with severe MR were operated more often than those with moderate MR. Patients with functional MR had reduced survival compared to patients with structural MR (p&amp;amp;amp;amp;lt;0.01). MR is a disease with greatly increased mortality and these data suggest a more aggressive approach to surgery.