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Title: | Interaction between secondary mitral regurgitation and left atrial function and their prognostic implications after cardiac resynchronization therapy | Authors: | STASSEN, Jan Galloo, Xavier Hirasawa, Kensuke van der Bijl, Pieter Leon, Martin B. Marsan, Nina Ajmone Bax, Jeroen J. |
Issue Date: | 2023 | Publisher: | OXFORD UNIV PRESS | Source: | European heart journal. Cardiovascular imaging (Print), 24 (4) , p. 532-541 | Abstract: | Aims Left atrial (LA) function is a strong prognostic marker in patients with heart failure and functional mitral regurgitation (MR). Although cardiac resynchronization therapy (CRT) has shown to improve MR severity, the interaction between a reduction in MR severity and an increase in LA function, as well as its association with outcomes, has not been investigated. Methods and results LA reservoir strain (RS) was evaluated with speckle tracking echocardiography in patients with at least moderate functional MR undergoing CRT implantation. MR improvement was defined as at least 1 grade improvement in MR severity at 6 months after CRT implantation. The primary endpoint was all-cause mortality. A total of 340 patients (mean age 66 +/- 10 years, 73% male) were included, of whom 200 (59%) showed MR improvement at 6 months follow-up. On multivariable analysis, an improvement in MR severity was independently associated with an increase in LARS (odds ratio 1.008; 95% confidence interval 1.003-1.013; P = 0.002). After multivariable adjustment, including baseline and follow-up variables, an increase in LARS was significantly associated with lower mortality. MR improvers showing LARS increasement had the lowest mortality rate, whereas outcomes were not significantly different between MR non-improvers and MR improvers showing no LARS increasement (P = 0.236). Conclusion A significant reduction in MR severity at 6 months after CRT implantation is independently associated with an increase in LARS. In addition, an increase in LARS is independently associated with lower all-cause mortality in patients with heart failure and significant functional MR. | Notes: | Bax, JJ (corresponding author), Leiden Univ, Dept Cardiol, Med Ctr, Albinusdreef 2, NL-2300 RC Leiden, Netherlands.; Bax, JJ (corresponding author), Univ Turku, Turku Heart Ctr, Kiinamyllynkatu 4-8, FI-20520 Turku, Finland.; Bax, JJ (corresponding author), Turku Univ Hosp, Kiinamyllynkatu 4-8, FI-20520 Turku, Finland. j.j.bax@lumc.nl |
Keywords: | functional mitral regurgitation;left atrial reservoir strain;heart failure;cardiac resynchronization therapy;mortality | Document URI: | http://hdl.handle.net/1942/38003 | ISSN: | 2047-2404 | e-ISSN: | 2047-2412 | DOI: | 10.1093/ehjci/jeac149 | ISI #: | 000834305300001 | Rights: | The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please email: journals.permissions@oup.com. | Category: | A1 | Type: | Journal Contribution |
Appears in Collections: | Research publications |
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