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Atrial Dysfunction in Significant Atrial Functional Mitral Regurgitation: Phenotypes and Prognostic Implications.
Dana Cramariuc1,2, Hassan Alfraidi3, Yasufumi Nagata4
1Department of Heart Disease, Haukeland University Hospital, Bergen, Norway (D.C.).
Circulation. Cardiovascular Imaging
|May 9, 2023
Summary
Left atrial reservoir function, measured by strain (LASr) and work (LAWr), predicts outcomes in atrial functional mitral regurgitation (AFMR). Impaired LA function, not size, is linked to increased mortality and heart failure hospitalizations.
Area of Science:
- Cardiology
- Echocardiography
- Cardiac Mechanics
Background:
- Atrial functional mitral regurgitation (AFMR) is linked to poor patient outcomes.
- The role of left atrial (LA) size and function in AFMR prognosis is not well understood.
Purpose of the Study:
- To evaluate LA reservoir strain (LASr) and reservoir work (LAWr) in AFMR patients.
- To determine the impact of LA function and size on clinical outcomes in AFMR.
Main Methods:
- Retrospective analysis of 515 AFMR patients (2001-2019).
- LA function assessed by LASr and LAWr (estimated as LASr × LA reservoir volume).
- Outcomes included all-cause death and heart failure hospitalizations.
Main Results:
- Lower LASr and LAWr were significantly associated with increased risk of death and heart failure hospitalizations.
- Impaired LA reservoir function, not LA size or left ventricular function, independently predicted mortality.
- These associations were particularly strong in patients with heart failure with preserved ejection fraction (HFpEF) and co-existing atrial fibrillation (AF).
Conclusions:
- LA reservoir function (LASr, LAWr) is a strong predictor of outcomes in significant AFMR.
- Functional LA changes, rather than geometric changes (LA size), are key determinants of prognosis in AFMR.
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