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

Abstract

Background Left atrial (LA) volumes and function are believed to improve following interventional reduction of mitral regurgitation (MR) with MitraClip. However, exact LA alterations after MitraClip in patients with functional MR and functional mitral regurgitation (FMR) are unknown. Objectives We aimed to evaluate the effect of MitraClip on LA volumes and global function in patients with FMR and its importance for patients' prognosis. Methods All patients underwent three‐dimensionally transthoracic echocardiography with an offline evaluation of LA geometry and strain analysis at baseline and follow‐up (FU). FU examinations were planned for 6 and 12 months after MitraClip. Results We prospectively included 50 consecutive surgical high‐risk (logistic EuroSCORE: 17.2 ± 13.9%) patients (77 ± 9 years, 22% female) with symptomatic moderate‐to‐severe to severe functional MR without atrial fibrillation. Echocardiographic evaluation showed that the E/E' ratio was significantly higher at FU (15.6 ± 7.3, 24.1 ± 13.2, p = .05) without relevant changes in systolic left ventricle (LV) function (p = .5). LA volumes (end‐diastolic volume [LA‐EDV] and end‐systolic volume [LA‐ESV]) (LA‐EDV: 83.1 ± 39.5 ml, 115.1 ± 55.3 ml, p = .012; LA‐ESV: 58.4 ± 33.4 ml, 80.1 ± 43.9 ml, p = .031), muscular mass (105.1 ± 49.3 g, 145.4 ± 70.6 g, p = .013), as well as LA stroke volume (24.6 ± 12.5 ml, 34.9 ± 19.1 ml, p = .016) significantly increased after the procedure. LA ejection fraction (LA‐EF: 31.7 ± 12.8%, 31.1 ± 12.3%, p = .8) and atrial global strain (aGS: −10.8 ± 5.4%, −9.7 ± 4.45%, p = .4) showed no significant changes at FU. Despite no relevant changes during FU, the baseline aGS was found to be the strongest predictor for mortality and adverse interventional outcome. Conclusion MitraClip increases atrial stroke volume, atrial volumes, and muscular mass in patients with FMR. We found that the baseline aGS the strongest predictor for mortality, rehospitalization, and higher residual MR at FU.

Impact of Cardiac Magnetic Resonance Left Atrial Ejection Fraction in Advanced Ischemic Cardiomyopathy

“… 28 Changes in LA function pre- and post-TEER have been demonstrated to be independently associated with adverse outcomes and are influenced by the success of the procedure. 31 , 32 Furthermore, while numerous previous studies have demonstrated the powerful prognostic importance of LVESVi, our current study suggests that LAEF is a more powerful risk factor than LVESVi in patients with advanced ICM.…”

Left Atrium: A New Prognostic Marker and Therapeutic Target in Secondary Mitral Regurgitation?

“…[ 56 ] Finally, Ozturk et al showed that baseline atrial global strain (aGS) was the strongest predictor of mortality and adverse outcomes after MitraClip; however, aGS exhibited no significant changes during follow-up. [ 57 ]…”

Atrial Cardiomyopathy in Valvular Heart Disease: From Molecular Biology to Clinical Perspectives

“…The cessation of or reduction in regurgitant volume after intervention reduce left atrial extension and pressure; however, the improvement in left atrial function might depend on preoperative strain values [ 169 ]. Improvement in atrial function after transcatheter mitral valve repair (e.g., MitraClip implantation) is controversial [ 169 , 170 , 171 , 172 , 173 , 174 , 175 ]. Some study groups have found improvements in left atrial function after the transcatheter procedure; however, others have found no relevant change or even worsening [ 169 , 170 , 171 , 172 , 173 , 174 , 175 ].…”

“…Improvement in atrial function after transcatheter mitral valve repair (e.g., MitraClip implantation) is controversial [ 169 , 170 , 171 , 172 , 173 , 174 , 175 ]. Some study groups have found improvements in left atrial function after the transcatheter procedure; however, others have found no relevant change or even worsening [ 169 , 170 , 171 , 172 , 173 , 174 , 175 ]. This might be due to the low study sample size and differences between study designs, including the etiology of mitral regurgitation, left ventricular function, the presence of atrial fibrillation, and the severity of residual mitral regurgitation after MitraClip implantation [ 169 , 170 , 171 , 172 , 173 , 174 , 175 ].…”