Quantified mitral regurgitation and left atrial function in heart failure with reduced ejection fraction: interplay and outcome implications

Malagoli, Alessandro; Rossi, Luca; Zanni, Alessia; Sticozzi, C; Piepoli, Massimo F; Benfari, Giovanni

doi:10.1002/ejhf.2429

Cited by 22 publications

(32 citation statements)

References 35 publications

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“…Conversely, the risk of events was less when FMR coexisted with a preserved global PALS (5‐year CV event rate 38 ± 6%). This different outcome for FMR patients with a comparable, less severe EROA but different PALS should underline, according to the authors, the role of left atrial properties in modulating prognosis in these patients 4 …”

Section: Figurementioning

confidence: 92%

“…In this issue of the Journal, Malagoli and colleagues move further their investigation addressing the complex interaction between peak atrial longitudinal strain (PALS), taken as an estimate of atrial compliance, and FMR reporting on a prospective study performed in 286 HFrEF patients with a complete follow‐up of 4.1 ± 1.5 years 4 . During this time period, the primary endpoint (defined as a composite of congestive heart failure hospitalization or cardiovascular [CV] death) occurred in 99 patients (35%).…”

Section: Figurementioning

confidence: 99%

“…Relative to that study, the authors of the current paper provide a differently quantified echocardiographic evaluation of left atrial function (PALS), mitral regurgitation (EROA), and heart failure biomarker (B‐type natriuretic peptide) encompassing a much larger HFrEF population followed for more than 5 years, coming to aligned conclusions 4 . Their findings underline the role of atrial mechanical characteristics in modulating symptoms and prognosis in these patients and suggest that atrial function should be considered in order to improve the selection of those to be proposed for more‐than‐mild degree percutaneous FMR correction 6 …”

Section: Figurementioning

confidence: 99%

See 2 more Smart Citations

Does left atrial deformation impact on symptoms and prognosis in functional mitral regurgitation patients with poor left ventricular function?

Marino

Zanaboni

2022

European J of Heart Fail

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Section: Figurementioning

confidence: 92%

Section: Figurementioning

confidence: 99%

Section: Figurementioning

confidence: 99%

See 1 more Smart Citation

Does left atrial deformation impact on symptoms and prognosis in functional mitral regurgitation patients with poor left ventricular function?

Marino

Zanaboni

2022

European J of Heart Fail

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“…Functional mitral regurgitation (FMR) has a well‐established prognostic impact in HF patients 25,26 . Malagoli et al 27 . analysed the role of FMR, quantified by effective regurgitant orifice area (EROA), on CV outcome and its interplay with left atrial (LA) function.…”

Section: Comorbiditiesmentioning

confidence: 99%

“…Functional mitral regurgitation (FMR) has a well-established prognostic impact in HF patients. 25,26 Malagoli et al 27 analysed the role of FMR, quantified by effective regurgitant orifice area (EROA), on CV outcome and its interplay with left atrial (LA) function. In this prospective cohort, including 286 HFrEF patients, EROA ≥0.30 cm 2 was associated with CV events regardless of LA function while LA function mitigated the effects of less severe FMR (EROA ≥0.10 cm 2 ).…”

Section: Mitral Regurgitationmentioning

confidence: 99%

April 2022 at a glance: focus on prevention, acute heart failure and heart failure with preserved ejection fraction

Tomasoni

Adamo

Metra

2022

European J of Heart Fail

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Spironolactone has proven effective in reducing heart failure (HF) hospitalizations in patients with HF and preserved ejection fraction (HFpEF). 1 A recent study randomized asymptomatic patients with left ventricular dysfunction, defined as global longitudinal strain ≤16% or diastolic abnormalities, to spironolactone or placebo. The primary endpoint was incident HF. The trial was prematurely terminated, and thus unpowered, because of a 55% withdrawal of spironolactone due to decline in renal function. However, resolution of left ventricular dysfunction occurred more frequently with spironolactone versus placebo (59% vs. 33%, p = 0.01). 2 Type 2 diabetes is a well-known cardiovascular (CV) risk factor. [3][4][5] In the ACCORD (Action to Control Cardiovascular Risk in Diabetes) study, patients with cardiac autonomic neuropathy, compared to those without, had a 2.7-fold higher risk to develop HF, over a median follow-up of 4.9 years. 6 Acute heart failureAn analysis from REPORT-HF (prospective international REgistry to assess medical Practice with lOngitudinal obseRvation for Treatment of Heart Failure) showed the precipitating factors leading to acute HF, focusing on inter-regional differences and outcome. 7 Acute coronary syndrome (ACS) was the most common cause of new-onset HF in all regions except Western Europe and North America. 7,8 On the other hand, non-adherence to diet/medication was the most common precipitant in patients with decompensated HF in all regions, confirming its major role for patient outcomes. 7,[9][10][11] Cardiogenic shock is still burdened by high mortality, requiring an early risk stratification. 12 Beer et al. 13 proposed a novel risk score, the Cardiogenic Shock Score (CSS), which was derived in 1308 unselected patients and validated in an external cohort of 943 patients. The novel score, based on nine clinical variables (age, sex, ACS, systolic blood pressure, heart rate, pH, lactate, glucose and cardiac arrest), had a higher prediction power compared to any other score in both the index and validation cohort.

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Incremental prognostic value of left atrial strain in patients with heart failure

Gao

Zhou

et al. 2022

ESC Heart Failure

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Aims The present study aimed to evaluate the prognostic value of atrial strain and strain rate (SR) parameters derived from cardiac magnetic resonance (CMR) feature tracking (FT) in patients with ischaemic and non‐ischaemic dilated cardiomyopathy with heart failure with reduced ejection fraction (HFrEF) but without atrial fibrillation. Methods and results A total of 300 patients who underwent CMR with left ventricular ejection fraction (LVEF) ≤ 40% and ischaemic or non‐ischaemic dilated cardiomyopathy were analysed in this retrospective study. Major adverse cardiac events (MACEs) include cardiovascular death, heart transplantation, and rehospitalization for worsening HF. Ninety‐four patients had MACEs during median follow‐up of 3.84 years. Multivariate Cox regression models adjusted for common clinical and CMR risk factors detected a significant association between LA‐εs and MACE in ischaemic (HR = 0.94/%; P = 0.002), non‐ischaemic dilated cardiomyopathy (HR = 0.88/%; P = 0.001), or all included patients (HR = 0.87; P < 0.001). LA‐εs provided incremental prognostic value over conventional outcome predictors (Uno C statistical comparison model: from 0.776 to 0.801, P < 0.0001; net reclassification improvement: 0.075, 95% CI: 0.0262–0.1301). Kaplan–Meier analysis revealed that the risk of MACE occurrence increased significantly with lower tertiles of left atrial reservoir strain (LA‐εs) (log‐rank P < 0.0001). Patients in the worst LA‐εs tertile faced a significantly increased risk of MACEs irrespective of late gadolinium enhancement (LGE) (log‐rank P < 0.0001). Conclusions LA‐εs derived from CMR FT has a significant prognostic impact on patients with ischaemic or non‐ischaemic dilated cardiomyopathy, incremental to common clinical and CMR risk‐factors.

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Quantified mitral regurgitation and left atrial function in heart failure with reduced ejection fraction: interplay and outcome implications

Cited by 22 publications

References 35 publications

Does left atrial deformation impact on symptoms and prognosis in functional mitral regurgitation patients with poor left ventricular function?

Does left atrial deformation impact on symptoms and prognosis in functional mitral regurgitation patients with poor left ventricular function?

April 2022 at a glance: focus on prevention, acute heart failure and heart failure with preserved ejection fraction

Incremental prognostic value of left atrial strain in patients with heart failure

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