Clip, Slip, and Grip
Impact on Left Atrial Strain
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It’s not that I’m so smart, it’s just that I stay with problems longer
The impact of severe organic mitral regurgitation (MR) on left atrium (LA) size and function has been studied; however, changes in LA function after mitral valve (MV) interventions remain unclear. In this issue of Circulation: Cardiovascular Imaging, Gucuk Ipek et al1 retrospectively studied LA and left ventricle (LV) strain by speckle-tracking echocardiography (STE) at baseline and at 12-month follow-up in 87 subjects with severe organic MR enrolled in the EVERST II trial (Endovascular Valve Edge-to-Edge Repair Study), including 49 patients who underwent MitraClip placement and 38 patients who underwent surgical MV repair (MVr). Their findings suggest that LA strain post-MV interventions is complicated and may be affected by multiple factors (Figure), including patient demographics, baseline LA size/function, treatment modalities and MR reduction, among others.
See Article by Gucuk Ipek et al
LA Size (Volume) and MR
Organic MR can lead to chronic volume overload on LA and consequent remodeling, which is manifested as LA dilatation and LA dysfunction. LA becomes less compliant because of chronic inflammation, LA myocyte hypertrophy, interstitial fibrosis, and decreased matrix metalloproteinase expression.2 LA volume index ≥40 mL/m2 is an independent predictor of atrial fibrillation and combined end point of death or need for mitral surgery in patients with organic MR.3 Baseline LA volume index and its progressive increase can predict the development of symptoms and LV dysfunction in asymptomatic patients with moderate and severe organic MR.4 Baseline LA volume index was also shown to strongly predict survival independent of MR severity and other known risk factors, and mitral surgery was shown to markedly improve outcomes and restore life expectancy.5
LA Function and MR
LA function …