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Reservoir Strain Outperforms Traditional Echocardiographic Parameters in Predicting Mortality in Secondary Mitral Regurgitation
Session:
SESSÃO DE POSTERS 38 - ANÁLISE DE DEFORMAÇÃO MIOCÁRDICA
Speaker:
Ricardo Carvalheiro
Congress:
CPC 2025
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.2 Valvular Heart Disease – Epidemiology, Prognosis, Outcome
Session Type:
Cartazes
FP Number:
---
Authors:
Ricardo Carvalheiro; Miguel Marques Antunes; Isabel Cardoso; José Miguel Viegas; Vera Vaz Ferreira; Pedro Rio; Ana Teresa Timóteo; Ana Galrinho; Rui Cruz Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction: </strong>Secondary mitral regurgitation (SMR) is associated with poor outcomes, yet the prognostic value of left atrial strain (LAS) and stiffness compared to traditional echocardiographic parameters remains unclear.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Objectives: </strong>To assess the prognostic significance of left atrial strain parameters and stiffness in predicting overall mortality in pts with SMR over 60 months.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong>We performed a single-center retrospective study of patients with SMR between 2018 to 2023.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results: </strong>The analysis included 96 pts (62% female) with a mean age of 67 ± 14 years, followed up (FUP) for a mean of 34 ± 22 months after TTE examination. 37 pts (39%) died during FUP after a median of 20 (IQR: 3–40) months.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Pts had a mean EROA of 32 ± 18 cm², regurgitant volume (RV) of 46 ± 24 mL, LVEF of 42 ± 12%, and peak TR velocity of 3.0 ± 0.5 m/s. LAS analysis revealed a mean reservoir strain (LAS-R) of 10 ± 5%, with an LA stiffness index (assessed as [E/e’]/[LAS-R]) of 2.0 ± 1.6. 47% of pts were in atrial fibrillation (AF) at the time of TTE examination. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Higher LAS-R values were a significant protective factor for mortality (HR = 0.88, 95% CI: 0.80–0.97, p = 0.007). Conversely, LA stiffness (HR = 1.27, 95% CI: 1.05–1.53, p = 0.016) and peak TR velocity (HR = 2.21, 95% CI: 1.15–4.26, p = 0.017) were associated with increased mortality risk over 60 months. Measures of regurgitation severity (e.g., RV or EROA), left and right ventricular systolic function (e.g., LVEF, GLS, or TAPSE), and other diastolic function parameters were not associated with mortality. Age was the only clinical variable independently associated with the outcome (HR = 1.03, 95% CI: 1.00–1.56, p = 0.049).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">While LA stiffness was a significant predictor in isolation, its effect weakened when included in a model with LAS-R (p = 0.594). In multivariate analysis, LAS-R remained a significant protective factor for mortality (HR = 0.865, 95% CI: 0.76–0.98, p = 0.023), while peak TR velocity showed a non-significant trend towards increased mortality risk (HR = 1.787, p = 0.193), after adjustment for LVEF and mitral regurgitation severity. The association between LAS and prognosis remained significant after adjusting for the pts’ rhythm.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion: </strong>Reservoir strain (LAS-R) emerges as a robust and independent predictor of mortality in pts with secondary mitral regurgitation, outperforming traditional echocardiographic markers such as LVEF or measures of regurgitation severity. Its protective role underscores the importance of evaluating atrial mechanics, providing a potential target for improved risk stratification in SMR.</span></span></p>
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