Preoperative left ventricular ejection fraction and left atrium reverse remodeling after mitral regurgitation surgery

Abstract

BackgroundLeft atrium enlargement has been associated with cardiac events in patients with mitral regurgitation (MR). Left atrium reverse remodeling (LARR) occur after surgical correction of MR, but the preoperative predictors of this phenomenon are not well known. It is therefore important to identify preoperative predictors for postoperative LARR.MethodsWe enrolled 62 patients with chronic severe MR (prolapse or flail leaflet) who underwent successful mitral valve surgery (repair or replacement); all with pre- and postoperative echocardiography. LARR was defined as a reduction in left atrium volume index (LAVI) of ≥25%. Stepwise multiple regression analysis was used to identify independent predictors of LARR.ResultsLARR occurred in 46 patients (74.2%), with the mean LAVI decreasing from 85.5 mL/m2 to 49.7 mL/m2 (p <0.001). These patients had a smaller preoperative left ventricular systolic volume (p =0.022) and a higher left ventricular ejection fraction (LVEF) (p =0.034). LVEF was identified as the only preoperative variable significantly associated with LARR (odds ratio, 1.086; 95% confidence interval, 1.002–1.178). A LVEF cutoff value of 63.5% identified patients with LARR of ≥25% with a sensitivity of 71.7% and a specificity of 56.3%.ConclusionsLARR occurs frequently after mitral valve surgery and is associated with preoperative LVEF higher than 63.5%.

Effects of Decreased Annular Height and Annular Saddle-Shaped Non-Planarity in Degenerative Severe Mitral Regurgitation with Normal Left Ventricular Ejection Fraction: Real-Time 3D Transesophageal Echocardiography

“…Another study suggested that MA size and reduced fractional area shortening were more related to LA rather than to LV size and dysfunction, at least in cases of degenerative severe MR with preserved LVEF 22). A decrease in LA size, or reverse remodeling, has been observed after MV surgery 10). In the present study, the LAVI obtained using echocardiography at least 6 months postoperatively was smaller in the normal annular height/BSA group than in the decreased annular height/BSA group.…”

“…Generally, a decrease in LA size, or reverse remodeling, has been observed after MV surgery. LA reverse remodeling occur after surgery of MR with preserved LV ejection fraction (LVEF) 10). One previous study concluded that MA dysfunction might be a prognostic factor for increased repair durability and MR recurrence after successful MV repair 11).…”

Results of Mitral Valve Surgery with Pulmonary Arterial Hypertension: Analysis of a Retrospective Study

“…After surgery, there was a significant reduction in the diameter of the left atrium for the majority of patients in both groups (Tables 4 and 5), regression of the size of the LA or reversibility of the remodeling, were observed after mitral valve surgery and it has been shown that the preoperative LVEF is the only variable closely associated with a postoperative reduction in LA diameter [23][24][25]. Some authors find a close association between LAD regression and reduction of cardiovascular events [11,21,23].…”

“…Some authors find a close association between LAD regression and reduction of cardiovascular events [11,21,23]. In the literature, the decline in the diameter of the LA was strongly observed after mitral surgery.…”

Myocardium Remodeling in the Heart Valves Disorders

“…Оценка процессов ремоделирования ЛЖ включает в себя измерение линейных размеров и определение расчетных показателей [44]. Одни ученые связывают ремоделирующий процесс с гипертрофией ЛЖ, другие изучают миокардиальный стресс, фракцию выброса ЛЖ, расчетные показатели формы ЛЖ и напряжения стенок, объемные показатели [45].…”