Atrial longitudinal strain parameters predict left atrial reverse remodeling after mitral valve surgery: a speckle tracking echocardiography study

Abstract

Volume overload in chronic severe mitral regurgitation (MR) causes left atrial (LA) remodeling. Volume overload generally diminishes after mitral valve surgery and LA size and shape are expected to recover. The recovery of LA functions named as reverse remodeling is said to be related with prognosis and mortality. A few clinical and echocardiographic parameters have been reported to be associated with LA reverse remodeling. In this study, we investigated the relationship between LA peak longitudinal strain (reservoir strain) assessed with 2-dimensional speckle tracking echocardiography (2D STE) and LA reverse remodeling. 53 patients (24 females and 29 males, mean age: 45.7 ± 13.5 years) with severe MR and preserved left ventricular systolic function were included in the study. All patients had normal sinus rhythm. The etiology of MR was mitral valve prolapse (MVP) in 37 patients and rheumatic valvular disease in 16 patients. Mitral valve repair was performed in 30 patients while 23 underwent mitral valve replacement. Echocardiography was performed before the surgery and 6 months later. LA peak atrial longitudinal strain (PALS) was assessed with speckle tracking imaging. LA reverse remodeling was defined as a percent of decrease in LA volume index (LAVI). Left atrial volume index significantly decreased after surgery (58.2 ± 16.6 vs. 43.9 ± 17.2 ml/m2, p ≤ 0.001). Mean LAVI reduction was 22.5 ± 27.2%. There was no significant difference in LAVI reduction between mitral repair and replacement groups (22.1 ± 22.6 vs. 23.1 ± 32.8 %, p = 0.9). Although the decrease in LAVI was higher in MVP group than rheumatic group, it was not statistically significant (24.4 ± 26.8 vs. 18.2 ± 28.9%, p = 0.4). Correlates of LAVI reduction were preoperative LAVI (r 0.28, p = 0.039), PALS (r 0.36, p = 0.001) and age (r -0.36, p = 0.007). Furthermore, in multivariate linear regression analysis (entering models), preoperative LAVI, age and PALS were all significant predictors of LA reverse remodeling (p ≤ 0.001, p = 0.04, p = 0.001 respectively). Left atrial peak longitudinal strain measured by 2D STE, in conjunction with preoperative LAVI and age is a predictor of LA reverse remodeling in patients undergoing surgery for severe MR. We suggest that in this patient population, PALS may also be used as a preoperative prognostic marker.

Early Detection of Bi-ventricular and Atrial Mechanical Dysfunction Using Two-Dimensional Speckle Tracking Echocardiography in Patients with Sarcoidosis

“…Atrial mechanical function can be successfully assessed using 2D STE [28]. This modality has revealed valuable information about the pathophysiological mechanisms of atrial remodeling [29,30]. We also demonstrated impaired left and right atrial reservoir functions in patients with sarcoidosis.…”

Cardiovascular imaging 2014 in the International Journal of Cardiovascular Imaging

“…A few clinical and echocardiographic parameters have been reported to be associated with left atrial reverse remodeling. Candan et al [14] investigated the relationship between left atrial peak longitudinal strain (reservoir strain) assessed with 2-dimensional speckle tracking echocardiography and left atrial reverse remodeling. 53 patients with severe mitral regurgitation and preserved left ventricular systolic function were included in the study.…”

The role of the left atrial function in the surgical management of aortic and mitral valve disease

“…Leaf atrial strain during reservoir phase has been univocally defined as a strong predictor of LA reverse remodeling in patients undergoing surgery for severe MR . The assessment of LA function provides an insight of the histopathological changes that occur in this chamber as the disease progresses, since LASr is strongly inverse correlated with atrial fibrosis in severe MR .…”

“…Leaf atrial strain during reservoir phase has been univocally defined as a strong predictor of LA reverse remodeling in patients undergoing surgery for severe MR. 31 The assessment of LA function provides an insight of the histopathological changes that occur in this chamber as the disease progresses, 32 since LASr is strongly inverse correlated with atrial fibrosis in severe MR. 33 In patients with chronic MR, LASr, which reflects LA compliance, is strongly influenced by the severity of the defect, reflecting its ability to express the worsening of MR and to be an indirect index of its duration. Indeed, in patients with mild MR, LASr appears to be higher than the normal value, following the Frank-Starling model (the mild increase in blood volume that arrives to LA increases LA contractility), whereas a highly depressed value characterizes severe MR 34 (Figure 3).…”