Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
J Am Soc Echocardiogr. 2013 Sep;26(9):1053-62. doi: 10.1016/j.echo.2013.05.019. Epub 2013 Jul 13.
Left atrial (LA) mechanics in patients with severe mitral regurgitation (MR) remain largely unexplored. The aim of the present evaluation was to assess the effect of severe MR on LA function, its potential relation with conventional surgical indications, and long-term postoperative survival.
Two-dimensional speckle-tracking strain and volumetric indices of LA reservoir, conduit, and contractile function were assessed in 121 patients with severe MR and 70 controls. Patients were divided according to the presence (n = 46) or absence (n = 75) of one or more guidelines-based criteria for mitral surgery (symptoms, left ventricular ejection fraction ≤ 60%, left ventricular end-systolic diameter ≥ 40 mm, atrial fibrillation, or systolic pulmonary arterial pressure >50 mm Hg).
In patients with severe MR compared with controls, significant LA reservoir and contractile dysfunction was observed, which was more pronounced in patients with mitral surgery indication (P < .05 for all strain and volumetric indices). Of all indices of LA function, LA reservoir strain was an independent predictor (odds ratio, 0.88; 95% confidence interval, 0.82-0.94; P < .001) and had the highest accuracy to identify patients with indications for mitral surgery (area under the receiver operating characteristic curve, 0.8; 95% confidence interval, 0.72-0.87). A total of 117 patients underwent mitral valve surgery. Patients with LA reservoir strain ≤24% showed worse survival at a median of 6.4 years (interquartile range, 4.7-8.7 years) after mitral surgery (P = .02), regardless the symptomatic status before surgery. LA reservoir strain, on top of mitral surgery indications, provided incremental predictive value for postoperative survival.
Impaired LA reservoir strain in patients with severe organic MR relates to long-term survival after mitral valve surgery, independently of and incremental to current guidelines-based indications for mitral surgery.
严重二尖瓣反流（MR）患者的左心房（LA）力学仍在很大程度上尚未得到探索。本评估的目的是评估严重 MR 对 LA 功能的影响，其与传统手术适应证的潜在关系以及长期术后生存。
在 121 例严重 MR 患者和 70 例对照者中评估了二维斑点追踪应变和 LA 储器、输送管和收缩功能的容积指数。根据是否存在（n = 46）或不存在（n = 75）一个或多个基于指南的二尖瓣手术适应证（症状、左心室射血分数≤60%、左心室收缩末期直径≥40mm、心房颤动或收缩性肺动脉压>50mmHg）将患者进行分组。
与对照组相比，严重 MR 患者的 LA 储器和收缩功能明显受损，而具有二尖瓣手术适应证的患者更为明显（所有应变和容积指数的 P 值均<.05）。在所有 LA 功能指标中，LA 储器应变是独立的预测因子（比值比，0.88；95%置信区间，0.82-0.94；P<.001），并且具有最高的准确性来识别具有二尖瓣手术适应证的患者（曲线下面积，0.8；95%置信区间，0.72-0.87）。共有 117 例患者接受了二尖瓣瓣膜手术。在二尖瓣手术后中位数为 6.4 年（四分位间距，4.7-8.7 年）时，LA 储器应变≤24%的患者生存状况较差（P =.02），无论手术前是否有症状。LA 储器应变，除了二尖瓣手术适应证外，还为术后生存提供了增量预测价值。
严重器质性 MR 患者的 LA 储器应变受损与二尖瓣瓣膜手术后的长期生存相关，独立于且优于当前基于指南的二尖瓣手术适应证。
