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Cardiovascular Ultrasound
Published in: Cardiovascular Ultrasound 1/2023

Open Access 01-12-2023 | Echocardiography | Research

Peak left atrial longitudinal strain is associated with all-cause mortality in patients with ventricular functional mitral regurgitation

Authors: Daniel A. Gomes, Pedro M. Lopes, Pedro Freitas, Francisco Albuquerque, Carla Reis, Sara Guerreiro, João Abecasis, Marisa Trabulo, António M. Ferreira, Jorge Ferreira, Regina Ribeiras, Miguel Mendes, Maria J. Andrade

Published in: Cardiovascular Ultrasound | Issue 1/2023

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Abstract

Purpose

Chronic mitral regurgitation promotes left atrial (LA) remodeling. However, the significance of LA dysfunction in the setting of ventricular functional mitral regurgitation (FMR) has not been fully investigated. Our aim was to assess the prognostic impact of peak atrial longitudinal strain (PALS), a surrogate of LA function, in patients with FMR and reduced left ventricular ejection fraction (LVEF).

Methods

Patients with at least mild ventricular FMR and LVEF < 50% under optimized medical therapy who underwent transthoracic echocardiography at a single center were retrospectively identified in the laboratory database. PALS was assessed by 2D speckle tracking in the apical 4-chamber view and the study population was divided in two groups according to the best cut-off value of PALS, using receiver operating characteristics (ROC) curve analysis. The primary endpoint-point was all-cause mortality.

Results

A total of 307 patients (median age 70 years, 77% male) were included. Median LVEF was 35% (IQR: 27 – 40%) and median effective regurgitant orifice area (EROA) was 15mm2 (IQR: 9 – 22mm2). According to current European guidelines, 32 patients had severe FMR (10%). During a median follow-up of 3.5 years (IQR 1.4 – 6.6), 148 patients died. The unadjusted mortality incidence per 100 persons-years increased with progressively lower values of PALS. On multivariable analysis, PALS remained independently associated with all-cause mortality (adjusted hazard ratio 1.052 per % decrease; 95% CI: 1.010 – 1.095; P = 0.016), even after adjustment for several (n = 14) clinical and echocardiographic confounders.

Conclusion

PALS is independently associated with all-cause mortality in patients with reduced LVEF and ventricular FMR.

Graphical Abstract

Appendix
Available only for authorised users
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Metadata
Title
Peak left atrial longitudinal strain is associated with all-cause mortality in patients with ventricular functional mitral regurgitation
Authors
Daniel A. Gomes
Pedro M. Lopes
Pedro Freitas
Francisco Albuquerque
Carla Reis
Sara Guerreiro
João Abecasis
Marisa Trabulo
António M. Ferreira
Jorge Ferreira
Regina Ribeiras
Miguel Mendes
Maria J. Andrade
Publication date
01-12-2023
Publisher
BioMed Central
Published in
Cardiovascular Ultrasound / Issue 1/2023
Electronic ISSN: 1476-7120
DOI
https://doi.org/10.1186/s12947-023-00307-7

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