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Left atrial remodeling in mitral regurgitation: A combined experimental-computational study
Sjoerd Bouwmeester1, Tim van Loon2, Meike Ploeg3
1Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
Plos One
|July 15, 2022
Summary
Mitral regurgitation initially boosts left atrial function but leads to progressive dilation and reduced function over time. This is linked to remodeling and fibrosis, as shown in canine models and simulations.
Area of Science:
- Cardiovascular Research
- Cardiac Physiology
- Medical Simulation
Background:
- Progressive changes in left atrial (LA) structure and function after mitral regurgitation (MR) are not fully understood.
- Investigating the underlying mechanisms of LA remodeling in MR is crucial for understanding disease progression.
Purpose of the Study:
- To elucidate the mechanisms behind progressive left atrial (LA) structural and functional changes following mitral regurgitation (MR).
- To utilize experimental canine models and computer simulations to demonstrate these underlying mechanisms.
Main Methods:
- Created a canine model of MR by chordae cauterization and induced left bundle-branch block (LBBB).
- Performed serial echocardiography, histology, and computer simulations to assess LA remodeling and function over 20 weeks.
- Compared the MR-LBBB group with a control group having LBBB alone.
Main Results:
- Acute MR initially increased LA reservoir and contractile strain, with no significant LA dilation.
- Over 20 weeks, LA strain decreased, and LA end-systolic area progressively increased in the MR-LBBB group.
- Histology indicated increased interstitial fibrosis in the LA of the MR-LBBB group; simulations confirmed remodeling and fibrosis as key factors.
Conclusions:
- Mitral regurgitation (MR) acutely enhances left atrial (LA) strain but leads to progressive LA dilation and decompensation over time.
- LA eccentric remodeling and fibrosis are identified as significant contributors to the observed progressive changes in LA structure and function.
- Computer simulations support the combined role of remodeling and fibrosis in the long-term consequences of MR on the LA.
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