Mitral regurgitation, left atrial structural and functional remodelling and the effect on pulmonary haemodynamics
Aims To assess the association between mitral regurgitation (MR) and left atrial (LA) structural and functional remodelling and their effect on pulmonary haemodynamics. Methods and results Consecutive unselected patients undergoing comprehensive echocardiography were enrolled. Parameters of cardiac...
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| Veröffentlicht in: | European journal of heart failure 2020-03, Vol.22 (3), p.499-506 |
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| creator | Inciardi, Riccardo M. Rossi, Andrea Bergamini, Corinna Benfari, Giovanni Maffeis, Caterina Greco, Carmen Drago, Andrea Guazzi, Marco Ribichini, Flavio L. Cicoira, Mariantonietta |
| description | Aims
To assess the association between mitral regurgitation (MR) and left atrial (LA) structural and functional remodelling and their effect on pulmonary haemodynamics.
Methods and results
Consecutive unselected patients undergoing comprehensive echocardiography were enrolled. Parameters of cardiac structure and function were obtained as well as mitral effective regurgitant orifice area (ERO) and estimation of pulmonary artery systolic pressure (PASP). Measures of LA structure [LA volume (LAV)] and function [peak atrial longitudinal strain (PALS), peak atrial contraction strain (PACS) and conduit strain (CS)] were also calculated. The study population included 102 patients (mean age 70 ± 14 years, 42% women), with a mean ejection fraction of 52 ± 13%. MR was classified as organic due to mitral valve prolapse in 14 patients (14%) and functional in 88 patients (86%). Mean ERO was 0.12 ± 0.12 cm2 and 86 patients (84%) had an ERO ≤0.2 cm2. ERO was significantly associated with worse measures of LA structure and function. Despite the low burden of MR, the association remained significant after adjusting for clinical and echocardiographic confounders (β: 3.7, P = 0.022 for LAV; β: −3.0, P = 0.003 for PALS; β: −1.8, P = 0.027 for PACS) and was significantly related with functional MR (P for interaction |
| doi_str_mv | 10.1002/ejhf.1677 |
| format | Article |
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To assess the association between mitral regurgitation (MR) and left atrial (LA) structural and functional remodelling and their effect on pulmonary haemodynamics.
Methods and results
Consecutive unselected patients undergoing comprehensive echocardiography were enrolled. Parameters of cardiac structure and function were obtained as well as mitral effective regurgitant orifice area (ERO) and estimation of pulmonary artery systolic pressure (PASP). Measures of LA structure [LA volume (LAV)] and function [peak atrial longitudinal strain (PALS), peak atrial contraction strain (PACS) and conduit strain (CS)] were also calculated. The study population included 102 patients (mean age 70 ± 14 years, 42% women), with a mean ejection fraction of 52 ± 13%. MR was classified as organic due to mitral valve prolapse in 14 patients (14%) and functional in 88 patients (86%). Mean ERO was 0.12 ± 0.12 cm2 and 86 patients (84%) had an ERO ≤0.2 cm2. ERO was significantly associated with worse measures of LA structure and function. Despite the low burden of MR, the association remained significant after adjusting for clinical and echocardiographic confounders (β: 3.7, P = 0.022 for LAV; β: −3.0, P = 0.003 for PALS; β: −1.8, P = 0.027 for PACS) and was significantly related with functional MR (P for interaction <0.001). ERO was also significantly associated with PASP, and measures of LA function (PALS and PACS) significantly modified this relationship (P for interaction <0.001).
Conclusions
Even a mild degree of MR contributes to LA remodelling and this relationship plays an active role in pulmonary circulation, suggesting a potential mechanism by which these parameters contribute to the development of heart failure.</description><identifier>ISSN: 1388-9842</identifier><identifier>EISSN: 1879-0844</identifier><identifier>DOI: 10.1002/ejhf.1677</identifier><identifier>PMID: 31793154</identifier><language>eng</language><publisher>Oxford, UK: John Wiley & Sons, Ltd</publisher><subject>Aged ; Aged, 80 and over ; Atrial Function, Left ; Echocardiography ; Female ; Heart Atria - diagnostic imaging ; Heart Failure ; Hemodynamics ; Humans ; Left atrium ; Male ; Middle Aged ; Mitral regurgitation ; Mitral Valve Insufficiency - diagnostic imaging ; Pulmonary haemodynamics</subject><ispartof>European journal of heart failure, 2020-03, Vol.22 (3), p.499-506</ispartof><rights>2019 European Society of Cardiology</rights><rights>2019 European Society of Cardiology.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3607-d800b5e575423a103bd0f108c8aad9884be7a9a91b075529388062fc96bba30f3</citedby><cites>FETCH-LOGICAL-c3607-d800b5e575423a103bd0f108c8aad9884be7a9a91b075529388062fc96bba30f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fejhf.1677$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fejhf.1677$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,1427,27901,27902,45550,45551,46384,46808</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31793154$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Inciardi, Riccardo M.</creatorcontrib><creatorcontrib>Rossi, Andrea</creatorcontrib><creatorcontrib>Bergamini, Corinna</creatorcontrib><creatorcontrib>Benfari, Giovanni</creatorcontrib><creatorcontrib>Maffeis, Caterina</creatorcontrib><creatorcontrib>Greco, Carmen</creatorcontrib><creatorcontrib>Drago, Andrea</creatorcontrib><creatorcontrib>Guazzi, Marco</creatorcontrib><creatorcontrib>Ribichini, Flavio L.</creatorcontrib><creatorcontrib>Cicoira, Mariantonietta</creatorcontrib><title>Mitral regurgitation, left atrial structural and functional remodelling and the effect on pulmonary haemodynamics</title><title>European journal of heart failure</title><addtitle>Eur J Heart Fail</addtitle><description>Aims
To assess the association between mitral regurgitation (MR) and left atrial (LA) structural and functional remodelling and their effect on pulmonary haemodynamics.
Methods and results
Consecutive unselected patients undergoing comprehensive echocardiography were enrolled. Parameters of cardiac structure and function were obtained as well as mitral effective regurgitant orifice area (ERO) and estimation of pulmonary artery systolic pressure (PASP). Measures of LA structure [LA volume (LAV)] and function [peak atrial longitudinal strain (PALS), peak atrial contraction strain (PACS) and conduit strain (CS)] were also calculated. The study population included 102 patients (mean age 70 ± 14 years, 42% women), with a mean ejection fraction of 52 ± 13%. MR was classified as organic due to mitral valve prolapse in 14 patients (14%) and functional in 88 patients (86%). Mean ERO was 0.12 ± 0.12 cm2 and 86 patients (84%) had an ERO ≤0.2 cm2. ERO was significantly associated with worse measures of LA structure and function. Despite the low burden of MR, the association remained significant after adjusting for clinical and echocardiographic confounders (β: 3.7, P = 0.022 for LAV; β: −3.0, P = 0.003 for PALS; β: −1.8, P = 0.027 for PACS) and was significantly related with functional MR (P for interaction <0.001). ERO was also significantly associated with PASP, and measures of LA function (PALS and PACS) significantly modified this relationship (P for interaction <0.001).
Conclusions
Even a mild degree of MR contributes to LA remodelling and this relationship plays an active role in pulmonary circulation, suggesting a potential mechanism by which these parameters contribute to the development of heart failure.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Atrial Function, Left</subject><subject>Echocardiography</subject><subject>Female</subject><subject>Heart Atria - diagnostic imaging</subject><subject>Heart Failure</subject><subject>Hemodynamics</subject><subject>Humans</subject><subject>Left atrium</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mitral regurgitation</subject><subject>Mitral Valve Insufficiency - diagnostic imaging</subject><subject>Pulmonary haemodynamics</subject><issn>1388-9842</issn><issn>1879-0844</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp10E1PwjAYB_DGaATRg1_A9KiJg6frRrujIeBLMF70vHRdCyV7gbaL4dvbAXrz1CbPr_88_SN0S2BMAOKJ2qz1mEwZO0NDwlkWAU-S83CnnEcZT-IBunJuA0BY4JdoQAnLKEmTIdq9G29Fha1adXZlvPCmbR5xpbTHwlsTRs7bTvquV6Ipse4a2aPDo7otVVWZZnUY-bXCSmslPW4bvO2qOjC7x2vRw30jaiPdNbrQonLq5nSO0Ndi_jl7iZYfz6-zp2Uk6RRYVHKAIlUpS5OYCgK0KEET4JILUWacJ4ViIhMZKYClaZyFr8I01jKbFoWgoOkI3R9zt7bddcr5vDZOhm1Fo9rO5TGNgTOSMgj04UilbZ2zSudba-qweU4g7xvO-4bzvuFg706xXVGr8k_-VhrA5Ai-TaX2_yfl87eXxSHyB1GZh3U</recordid><startdate>202003</startdate><enddate>202003</enddate><creator>Inciardi, Riccardo M.</creator><creator>Rossi, Andrea</creator><creator>Bergamini, Corinna</creator><creator>Benfari, Giovanni</creator><creator>Maffeis, Caterina</creator><creator>Greco, Carmen</creator><creator>Drago, Andrea</creator><creator>Guazzi, Marco</creator><creator>Ribichini, Flavio L.</creator><creator>Cicoira, Mariantonietta</creator><general>John Wiley & Sons, Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202003</creationdate><title>Mitral regurgitation, left atrial structural and functional remodelling and the effect on pulmonary haemodynamics</title><author>Inciardi, Riccardo M. ; Rossi, Andrea ; Bergamini, Corinna ; Benfari, Giovanni ; Maffeis, Caterina ; Greco, Carmen ; Drago, Andrea ; Guazzi, Marco ; Ribichini, Flavio L. ; Cicoira, Mariantonietta</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3607-d800b5e575423a103bd0f108c8aad9884be7a9a91b075529388062fc96bba30f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Atrial Function, Left</topic><topic>Echocardiography</topic><topic>Female</topic><topic>Heart Atria - diagnostic imaging</topic><topic>Heart Failure</topic><topic>Hemodynamics</topic><topic>Humans</topic><topic>Left atrium</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mitral regurgitation</topic><topic>Mitral Valve Insufficiency - diagnostic imaging</topic><topic>Pulmonary haemodynamics</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Inciardi, Riccardo M.</creatorcontrib><creatorcontrib>Rossi, Andrea</creatorcontrib><creatorcontrib>Bergamini, Corinna</creatorcontrib><creatorcontrib>Benfari, Giovanni</creatorcontrib><creatorcontrib>Maffeis, Caterina</creatorcontrib><creatorcontrib>Greco, Carmen</creatorcontrib><creatorcontrib>Drago, Andrea</creatorcontrib><creatorcontrib>Guazzi, Marco</creatorcontrib><creatorcontrib>Ribichini, Flavio L.</creatorcontrib><creatorcontrib>Cicoira, Mariantonietta</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of heart failure</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Inciardi, Riccardo M.</au><au>Rossi, Andrea</au><au>Bergamini, Corinna</au><au>Benfari, Giovanni</au><au>Maffeis, Caterina</au><au>Greco, Carmen</au><au>Drago, Andrea</au><au>Guazzi, Marco</au><au>Ribichini, Flavio L.</au><au>Cicoira, Mariantonietta</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Mitral regurgitation, left atrial structural and functional remodelling and the effect on pulmonary haemodynamics</atitle><jtitle>European journal of heart failure</jtitle><addtitle>Eur J Heart Fail</addtitle><date>2020-03</date><risdate>2020</risdate><volume>22</volume><issue>3</issue><spage>499</spage><epage>506</epage><pages>499-506</pages><issn>1388-9842</issn><eissn>1879-0844</eissn><abstract>Aims
To assess the association between mitral regurgitation (MR) and left atrial (LA) structural and functional remodelling and their effect on pulmonary haemodynamics.
Methods and results
Consecutive unselected patients undergoing comprehensive echocardiography were enrolled. Parameters of cardiac structure and function were obtained as well as mitral effective regurgitant orifice area (ERO) and estimation of pulmonary artery systolic pressure (PASP). Measures of LA structure [LA volume (LAV)] and function [peak atrial longitudinal strain (PALS), peak atrial contraction strain (PACS) and conduit strain (CS)] were also calculated. The study population included 102 patients (mean age 70 ± 14 years, 42% women), with a mean ejection fraction of 52 ± 13%. MR was classified as organic due to mitral valve prolapse in 14 patients (14%) and functional in 88 patients (86%). Mean ERO was 0.12 ± 0.12 cm2 and 86 patients (84%) had an ERO ≤0.2 cm2. ERO was significantly associated with worse measures of LA structure and function. Despite the low burden of MR, the association remained significant after adjusting for clinical and echocardiographic confounders (β: 3.7, P = 0.022 for LAV; β: −3.0, P = 0.003 for PALS; β: −1.8, P = 0.027 for PACS) and was significantly related with functional MR (P for interaction <0.001). ERO was also significantly associated with PASP, and measures of LA function (PALS and PACS) significantly modified this relationship (P for interaction <0.001).
Conclusions
Even a mild degree of MR contributes to LA remodelling and this relationship plays an active role in pulmonary circulation, suggesting a potential mechanism by which these parameters contribute to the development of heart failure.</abstract><cop>Oxford, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>31793154</pmid><doi>10.1002/ejhf.1677</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| source | Wiley Free Content; MEDLINE; Wiley Online Library Journals Frontfile Complete; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Aged Aged, 80 and over Atrial Function, Left Echocardiography Female Heart Atria - diagnostic imaging Heart Failure Hemodynamics Humans Left atrium Male Middle Aged Mitral regurgitation Mitral Valve Insufficiency - diagnostic imaging Pulmonary haemodynamics |
| title | Mitral regurgitation, left atrial structural and functional remodelling and the effect on pulmonary haemodynamics |
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