Left Atrial Function Is Associated with Earlier Need for Cardiac Surgery in Moderate to Severe Mitral Regurgitation: Usefulness in Targeting for Early Surgery

Abstract

LA function is independently associated with surgery-free survival in patients with mitral valve prolapse and moderate to severe mitral regurgitation. Quantitative assessment of LA function may have clinical utility in guiding early surgical intervention in these patients.

Concerning “Left Atrial Function Is Associated with Earlier Need for Cardiac Surgery in Moderate to Severe Mitral Regurgitation: Usefulness in Targeting for Early Surgery”

“…In actual fact, we agree entirely with Koutroulis et al 1 : without doubt, abnormal or impaired LA deformation is a consequence of LA remodeling and dilatation. In the context of chronic mitral regurgitation (MR), LA enlargement is itself proportional to the volume of MR but also likely reflects alterations in left ventricular (LV) compliance.…”

“…Although we do not disagree with Koutroulis et al 1 in this regard, we would assert that the assessment of LA function provides additional information to the clinician, rendering it superior to an isolated assessment of LA volume when assessing patients with MR.…”

“…We would like to thank Koutroulis et al 1 for their kind comments regarding our report, 2 and we welcome the opportunity to discuss the points they raise. Specifically, they suggest that speckle strain indices of the left atrium are reflective of the degree of tissue remodeling in the stretched left atrium and propose that the primary abnormality is dilatation of the left atrium, which subsequently results in impaired left atrial (LA) deformation.…”

“…We wonder whether there was a misunderstanding on the part of Koutroulis et al 1 In our original report, we stated that ''contractile and reservoir strain [of the left atrium] display subtle early alterations that precede the development of clinical or echocardiographic features that mandate intervention.'' We did not state that changes in LA deformation indices preceded remodeling of the left atrium, as they appear to be implying in their letter.…”

Left atrial global function in chronic heart failure patients with functional mitral regurgitation after MitraClip

“…6 The assessment of LA function and geometry is established for patient selection and timing of mitral valve (MV) repair. [7][8][9][10] However, adequate assessment of LA function is challenging. 2D echocardiography obtains conventional static parameters of LA function.…”