Anatomic and Functional Determinants of Atrial Functional Mitral Regurgitation

Matta, Milad; Ayoub, Chadi; Hassan, Ossama K. Abou; Layoun, Habib; Cremer, Paul; Hussein, Ayman A.; Schoenhagen, Paul; Saliba, Walid; Rodriguez, L. Leonardo; Griffin, Brian P.; Kapadia, Samir; Harb, Serge C.

doi:10.1080/24748706.2021.1943765

Cited by 7 publications

(4 citation statements)

References 44 publications

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“…In the study by Abe et al ,28 the presence of concomitant significant MR and TR among 298 patients with AF and preserved LVEF identified a subset of patients (n=11) with worse outcome at a mean follow-up of 24 months. Similarly, TR grading was reported as an independent prognostic marker in a small cohort (n=90) of patients with at least moderate-to-severe AFMR, together with age, renal function and LV end-systolic dimensions 20. The present study confirmed this finding in a larger population of patients with significant AFMR and with longer follow-up duration.…”

Section: Discussionsupporting

confidence: 88%

“…Among them, LA dysfunction and reduced LV longitudinal mechanics have been described as potential triggers of AFMR in subjects with LA dilatation 1 8. Patients with AFMR showed impaired values of LV GLS and LAS, as compared with patients with AF but without AFMR 8 20. These differences remained in patients with comparable LA and LV dimensions and LVEF 8.…”

Section: Discussionmentioning

confidence: 99%

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Prognostic impact of left ventricular global longitudinal strain in atrial mitral regurgitation

Meucci

Stassen

Tomšič

et al. 2022

Heart

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ObjectiveLeft atrial (LA) and left ventricular (LV) mechanics are impaired in patients with atrial functional mitral regurgitation (AFMR), but their prognostic value in this subset of patients remains unknown. The present study aimed to evaluate the association between LA and LV longitudinal strain and clinical outcomes in patients with AFMR.MethodsA total of 197 patients (mean age 73±10 years, 44% men) with at least moderate AFMR were retrospectively identified. LV global longitudinal strain (GLS) and left atrial reservoir strain (LAS) were calculated by two-dimensional speckle tracking echocardiography. All-cause mortality was the primary endpoint of the study. The threshold value of LV GLS (≤16.3%) to identify impaired LV mechanics was defined based on the risk excess of the primary endpoint described with a spline curve analysis.ResultsImpaired LV GLS (≤16.3%) was found in 89 (45%) patients. During a median follow-up of 69 months, 45 (23%) subjects experienced the primary endpoint. Patients with impaired LV GLS (≤16.3%) had a significantly lower cumulative survival rate at 5 years, as compared with patients with LV GLS (>16.3%) (74% vs 93%, p<0.001). On multivariable Cox regression analysis, LV GLS expressed as continuous variable was independently associated with the occurrence of all-cause mortality (HR 0.856, 95% CI 0.763 to 0.960; p=0.008) after adjustment for age, LAS, pulmonary artery systolic pressure and severe tricuspid regurgitation. Conversely, LAS was not significantly associated with patients’ outcome.ConclusionsIn patients with significant AFMR, the impairment of LV GLS was independently associated with worse outcomes.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Prognostic impact of left ventricular global longitudinal strain in atrial mitral regurgitation

Meucci

Stassen

Tomšič

et al. 2022

Heart

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“…From one side, ventricular dysfunction/enlargement leads to apical tethering of the leaflets with increased tenting, as has been typically described in ventricular SMR 3 21. On the other side, the concomitant presence of SAD is associated with outward annular stretching and flattening of the leaflets as has been described with atrial SMR 22–24. Our findings support an additive effect whereby the leaflets are tethered by the ventricular component but to a lesser extent due to the atrial component.…”

Section: Discussionsupporting

confidence: 83%

Clinical, functional and prognostic implications of severe atrial dilation in secondary mitral regurgitation

et al. 2022

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ObjectiveAtrial dilation is known to be a poor prognostic indicator. However, its clinical, functional and prognostic implications have not been thoroughly explored in secondary mitral regurgitation (SMR). We sought to describe the implications of severe atrial dilation (SAD) in SMR.MethodsWe included all adult patients with severe SMR due to left ventricle dysfunction (with no organic mitral valve disease) who underwent transthoracic echocardiography between January 2012 and March 2021 at our institution. The concomitant presence of severe left atrial (LA) dilation (>48 mL/m2) defined SADMR (SAD in SMR), and these patients were compared with those without SAD.ResultsA total of 2011 patients were included (mean age 70% and 41% females), with 71% having SADMR. MR severity and ejection fraction were similar between both groups. Patients with SADMR were older, less females and had more diabetes, but similar rates of atrial fibrillation. Mechanistically, they had lower A wave velocity (0.61 vs 0.72 cm/sec, p<0.001) and more impaired LA reservoir strain (9.7% vs 15.5%, p<0.001). Geometrically, SADMR had shallower leaflets’ angulations, lower tenting height, larger annuli and smaller leaflet length/annular diameter ratios (all p<0.001). They underwent fewer MV interventions, although these were associated with better outcomes (log-rank p<0.001). Over the study period, SAD was an independent predictor of mortality (HR 1.26, p=0.04).ConclusionSADMR is associated with specific mechanistic and functional alterations and confers a worse prognosis.

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“…Atrial dilation and dysfunction, in the absence of ventricular dysfunction, could cause another subtype of SMR, referred to as atrial SMR. 21 In contrast to changes seen in ventricular SMR, the mitral valve leaflets have shallower tenting angles and height, 22 which could pose different anatomic challenges to the TEER procedure. In recent retrospective studies, MR reduction to ≤ 1+ was successful in ~80% of atrial SMR cases, which was significantly correlated with lower left atrial volume and higher leaflet to annulus ratio.…”

Section: Teer In Secondary Mrmentioning

confidence: 99%

Patient Selection for Mitral Transcatheter Edge-to-Edge Repair

Layoun¹,

Harb²,

Krishnaswamy³

et al. 2023

Methodist DeBakey Cardiovascular Journal

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Mitral regurgitation (MR) is one of the most common valvular heart diseases, with many patients remaining non-suitable for surgical interventions. Transcatheter edge-to-edge repair (TEER) is a rapidly evolving procedure that allows safe and effective reduction of MR in high-risk patients. However, adequate patient selection through clinical assessment and imaging modalities remains a key factor for procedural success. In the following review, we highlight recent developments in TEER technologies that are expanding the target population and currently available imaging modalities that allow detailed evaluation of the mitral valve and surrounding structures for optimal patient selection.

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Anatomic and Functional Determinants of Atrial Functional Mitral Regurgitation

Cited by 7 publications

References 44 publications

Prognostic impact of left ventricular global longitudinal strain in atrial mitral regurgitation

Prognostic impact of left ventricular global longitudinal strain in atrial mitral regurgitation

Clinical, functional and prognostic implications of severe atrial dilation in secondary mitral regurgitation

Patient Selection for Mitral Transcatheter Edge-to-Edge Repair

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