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Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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Prognostic significance of peak atrial longitudinal strain in patients with functional mitral regurgitation
Session:
Posters (Sessão 4 - Écran 1) - Imagem 2 - Ecocardiografia 1
Speaker:
Daniel A. Gomes
Congress:
CPC 2022
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Daniel a. Gomes; Pedro m. Lopes; Pedro Freitas; Francisco Albuquerque; Eduarda Horta; Carla Reis; Sara Guerreiro; João Abecasis; Marisa Trabulo; António m. Ferreira; Jorge Ferreira; Regina Ribeiras; Miguel Mendes; Maria João Andrade
Abstract
<p><strong>Background </strong></p> <p>Chronic mitral regurgitation has been shown to promote left atrial (LA) dysfunction and remodeling. However, the significance of LA dysfunction in this setting has not been fully investigated. The aim of our study was to assess the prognostic impact of peak atrial longitudinal strain (PALS), a surrogate of LA function, in a cohort of patients with left ventricular systolic dysfunction and functional mitral regurgitation (FMR).</p> <p> </p> <p><strong>Methods</strong></p> <p>Patients with at least mild FMR and reduced left ventricular ejection fraction (LVEF < 50%) under optimized medical therapy who underwent transthoracic echocardiography between 2010 and 2018 were retrospectively identified at a single-centre. FMR grading was undertaken according to the new 2021 European Society of Cardiology (ESC) guidelines for the management of valvular heart disease. PALS was assessed by 2D speckle tracking in apical 4-chamber view (as per European Association of Cardiovascular Imaging current recommendations). Cox proportional hazards regression was applied for univariable and multivariable analysis to investigate the association between clinical and echocardiographic parameters, namely PALS, and all-cause mortality.</p> <p> </p> <p><strong>Results</strong></p> <p>A total of 307 patients (median age 70 years, 77% male) were included. Median LVEF was 35% (IQR: 27 – 40%) and median mitral regurgitant volume was 25mL (IQR: 14 – 34mL). According to the new ESC 2021 valvular guidelines, 32 patients had severe FMR (10%). During a median follow-up of 3.5 years (IQR 1.4 – 6.6), 148 patients died. Median PALS was 14% (IQR 8 – 20%). The unadjusted mortality incidence per 100 persons-years increased with progressively lower values of PALS (figure 1A). On ROC curve analysis, the best PALS cut-off value associated with mortality was < 15%. Kaplan-Meier survival curves according to FMR severity and PALS > or < 15% are depicted in figure 1B. PALS remained independently associated with all-cause mortality on multivariable analysis (adjusted hazard ratio [aHR]: 0.94; 95%CI: 0.90–0.98; p = 0.004) even after adjustment for several (n=14) clinical and echocardiographic confounders.</p> <p> </p> <p><strong>Conclusion</strong></p> <p>In a cohort of patients with reduced LVEF and functional mitral regurgitation, peak atrial longitudinal strain was associated with all-cause mortality.</p>
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