Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, NO-5021 Bergen, Norway.
Department of Clinical Science, University of Bergen, Jonas Lies vei 87, NO-5021 Bergen, Norway.
Eur Heart J Cardiovasc Imaging. 2024 Jul 31;25(8):1118-1126. doi: 10.1093/ehjci/jeae072.
Mitral regurgitation (MR) causes left atrial (LA) enlargement and impaired reservoir function. We assessed whether changes in LA size, strain, and stiffness in significant (moderate or greater) primary MR are sex-specific.
In the 3D Echocardiography and Cardiovascular Prognosis in Mitral Regurgitation study, 111 patients with primary MR were prospectively investigated with 2D and 3D echocardiography. MR was severe if the 3D regurgitant fraction was ≥50%. LA size was assessed by maximum, minimum, and pre-A 3D volume (LAV), mechanics by peak reservoir (LASr) and contractile strain, and stiffness by the ratio: mitral peak E-wave divided by the annular e' velocity (E/e')/LASr. Women were older, had higher heart rate, and lower body mass index and MR regurgitant volumes (P < 0.05). 3D LAV indexed for body surface area and LA contractile strain did not differ by sex, while LASr was lower (22.2 vs. 25.0%) and LA stiffness higher in women (0.56 vs. 0.44) (P < 0.05). In linear regression analysis, female sex was associated with higher LA stiffness independent of age, minimum LAV, left ventricular global longitudinal strain, diabetes, and coronary artery disease (R2 = 0.56, all P < 0.05). In logistic regression analysis, women had a four-fold (95% CI 1.2-13.1, P = 0.02) higher adjusted risk of increased LA stiffness than men.
Women with significant primary MR have more impaired LA reservoir mechanics and increased LA stiffness compared with men despite lower MR regurgitant volumes and similar indexed LA size. The findings reveal sex-specific features of LA remodeling in MR.
ClinicalTrials.gov Identifier: NCT04442828.
二尖瓣反流（MR）导致左心房（LA）扩大和储备功能受损。我们评估了在有明显（中度或更严重）原发性 MR 的患者中，LA 大小、应变和僵硬的变化是否具有性别特异性。
在 3D 超声心动图和二尖瓣反流心血管预后研究中，前瞻性调查了 111 例原发性 MR 患者的 2D 和 3D 超声心动图。如果 3D 反流分数≥50%，则认为 MR 严重。LA 大小通过最大、最小和 Pre-A 3D 容积（LAV）评估，力学通过峰值储备（LASr）和收缩应变评估，僵硬度通过二尖瓣峰值 E 波除以环 e'速度（E/e'）/LASr 的比值评估。女性年龄较大，心率较高，体重指数和 MR 反流容积较低（P < 0.05）。3D LAV 按体表面积和 LA 收缩应变指数无性别差异，而 LASr 较低（22.2% vs. 25.0%），女性 LA 僵硬度较高（0.56 vs. 0.44）（P < 0.05）。在线性回归分析中，女性性别与较高的 LA 僵硬度独立相关，与年龄、最小 LAV、左心室整体纵向应变、糖尿病和冠状动脉疾病无关（R2 = 0.56，均 P < 0.05）。在逻辑回归分析中，与男性相比，女性 LA 僵硬度增加的调整风险高 4 倍（95%CI 1.2-13.1，P = 0.02）。
与男性相比，有明显原发性 MR 的女性尽管 MR 反流容积较低且 LA 大小指数相似，但 LA 储备力学受损更严重，LA 僵硬度增加。这些发现揭示了 MR 中 LA 重塑的性别特异性特征。
ClinicalTrials.gov 标识符：NCT04442828。
