Prognostic impact of left ventricular global longitudinal strain in atrial mitral regurgitation
ObjectiveLeft atrial (LA) and left ventricular (LV) mechanics are impaired in patients with atrial functional mitral regurgitation (AFMR), but their prognostic value in this subset of patients remains unknown. The present study aimed to evaluate the association between LA and LV longitudinal strain...
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| Veröffentlicht in: | Heart (British Cardiac Society) 2023-03, Vol.109 (6), p.478-484 |
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| creator | Meucci, Maria Chiara Stassen, Jan Tomsic, Anton Palmen, Meindert Crea, Filippo Bax, Jeroen J Ajmone Marsan, Nina Delgado, Victoria |
| description | ObjectiveLeft atrial (LA) and left ventricular (LV) mechanics are impaired in patients with atrial functional mitral regurgitation (AFMR), but their prognostic value in this subset of patients remains unknown. The present study aimed to evaluate the association between LA and LV longitudinal strain and clinical outcomes in patients with AFMR.MethodsA total of 197 patients (mean age 73±10 years, 44% men) with at least moderate AFMR were retrospectively identified. LV global longitudinal strain (GLS) and left atrial reservoir strain (LAS) were calculated by two-dimensional speckle tracking echocardiography. All-cause mortality was the primary endpoint of the study. The threshold value of LV GLS (≤16.3%) to identify impaired LV mechanics was defined based on the risk excess of the primary endpoint described with a spline curve analysis.ResultsImpaired LV GLS (≤16.3%) was found in 89 (45%) patients. During a median follow-up of 69 months, 45 (23%) subjects experienced the primary endpoint. Patients with impaired LV GLS (≤16.3%) had a significantly lower cumulative survival rate at 5 years, as compared with patients with LV GLS (>16.3%) (74% vs 93%, p |
| doi_str_mv | 10.1136/heartjnl-2022-321698 |
| format | Article |
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The present study aimed to evaluate the association between LA and LV longitudinal strain and clinical outcomes in patients with AFMR.MethodsA total of 197 patients (mean age 73±10 years, 44% men) with at least moderate AFMR were retrospectively identified. LV global longitudinal strain (GLS) and left atrial reservoir strain (LAS) were calculated by two-dimensional speckle tracking echocardiography. All-cause mortality was the primary endpoint of the study. The threshold value of LV GLS (≤16.3%) to identify impaired LV mechanics was defined based on the risk excess of the primary endpoint described with a spline curve analysis.ResultsImpaired LV GLS (≤16.3%) was found in 89 (45%) patients. During a median follow-up of 69 months, 45 (23%) subjects experienced the primary endpoint. Patients with impaired LV GLS (≤16.3%) had a significantly lower cumulative survival rate at 5 years, as compared with patients with LV GLS (>16.3%) (74% vs 93%, p<0.001). On multivariable Cox regression analysis, LV GLS expressed as continuous variable was independently associated with the occurrence of all-cause mortality (HR 0.856, 95% CI 0.763 to 0.960; p=0.008) after adjustment for age, LAS, pulmonary artery systolic pressure and severe tricuspid regurgitation. Conversely, LAS was not significantly associated with patients’ outcome.ConclusionsIn patients with significant AFMR, the impairment of LV GLS was independently associated with worse outcomes.</description><identifier>ISSN: 1355-6037</identifier><identifier>EISSN: 1468-201X</identifier><identifier>DOI: 10.1136/heartjnl-2022-321698</identifier><identifier>PMID: 36270784</identifier><language>eng</language><publisher>England: BMJ Publishing Group Ltd and British Cardiovascular Society</publisher><subject>Aged ; Aged, 80 and over ; Atrial Fibrillation ; Cardiology ; Cardiovascular disease ; echocardiography ; Ejection fraction ; Female ; Global Longitudinal Strain ; Heart ; Humans ; Information systems ; Male ; Mechanics ; Middle Aged ; Mitral Valve Insufficiency ; Mortality ; Patients ; Prognosis ; Pulmonary arteries ; Retrospective Studies ; Software ; Stroke Volume ; Survival analysis ; Valvular heart disease ; Ventricular Dysfunction, Left ; Ventricular Function, Left</subject><ispartof>Heart (British Cardiac Society), 2023-03, Vol.109 (6), p.478-484</ispartof><rights>Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2022 Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2023 Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b404t-714b5bb490b745c25371d230f5f19f30026659160eb7011fe74c1d45e70240e3</citedby><cites>FETCH-LOGICAL-b404t-714b5bb490b745c25371d230f5f19f30026659160eb7011fe74c1d45e70240e3</cites><orcidid>0000-0002-7213-5452 ; 0000-0002-9860-4886 ; 0000-0002-9841-2737 ; 0000-0001-9745-5498</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36270784$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Meucci, Maria Chiara</creatorcontrib><creatorcontrib>Stassen, Jan</creatorcontrib><creatorcontrib>Tomsic, Anton</creatorcontrib><creatorcontrib>Palmen, Meindert</creatorcontrib><creatorcontrib>Crea, Filippo</creatorcontrib><creatorcontrib>Bax, Jeroen J</creatorcontrib><creatorcontrib>Ajmone Marsan, Nina</creatorcontrib><creatorcontrib>Delgado, Victoria</creatorcontrib><title>Prognostic impact of left ventricular global longitudinal strain in atrial mitral regurgitation</title><title>Heart (British Cardiac Society)</title><addtitle>Heart</addtitle><addtitle>Heart</addtitle><description>ObjectiveLeft atrial (LA) and left ventricular (LV) mechanics are impaired in patients with atrial functional mitral regurgitation (AFMR), but their prognostic value in this subset of patients remains unknown. The present study aimed to evaluate the association between LA and LV longitudinal strain and clinical outcomes in patients with AFMR.MethodsA total of 197 patients (mean age 73±10 years, 44% men) with at least moderate AFMR were retrospectively identified. LV global longitudinal strain (GLS) and left atrial reservoir strain (LAS) were calculated by two-dimensional speckle tracking echocardiography. All-cause mortality was the primary endpoint of the study. The threshold value of LV GLS (≤16.3%) to identify impaired LV mechanics was defined based on the risk excess of the primary endpoint described with a spline curve analysis.ResultsImpaired LV GLS (≤16.3%) was found in 89 (45%) patients. During a median follow-up of 69 months, 45 (23%) subjects experienced the primary endpoint. Patients with impaired LV GLS (≤16.3%) had a significantly lower cumulative survival rate at 5 years, as compared with patients with LV GLS (>16.3%) (74% vs 93%, p<0.001). On multivariable Cox regression analysis, LV GLS expressed as continuous variable was independently associated with the occurrence of all-cause mortality (HR 0.856, 95% CI 0.763 to 0.960; p=0.008) after adjustment for age, LAS, pulmonary artery systolic pressure and severe tricuspid regurgitation. Conversely, LAS was not significantly associated with patients’ outcome.ConclusionsIn patients with significant AFMR, the impairment of LV GLS was independently associated with worse outcomes.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Atrial Fibrillation</subject><subject>Cardiology</subject><subject>Cardiovascular disease</subject><subject>echocardiography</subject><subject>Ejection fraction</subject><subject>Female</subject><subject>Global Longitudinal Strain</subject><subject>Heart</subject><subject>Humans</subject><subject>Information systems</subject><subject>Male</subject><subject>Mechanics</subject><subject>Middle Aged</subject><subject>Mitral Valve Insufficiency</subject><subject>Mortality</subject><subject>Patients</subject><subject>Prognosis</subject><subject>Pulmonary arteries</subject><subject>Retrospective Studies</subject><subject>Software</subject><subject>Stroke Volume</subject><subject>Survival analysis</subject><subject>Valvular heart disease</subject><subject>Ventricular Dysfunction, Left</subject><subject>Ventricular Function, Left</subject><issn>1355-6037</issn><issn>1468-201X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNp9kUtLAzEYRYMoWh__QGTAjZvRL49JZpZSfEFBFy7chWSaqSmZSU0ygv_elFoFF4VAksv5bggHoXMM1xhTfvNuVEjLwZUECCkpwbyp99AEM17nCL_t5zOtqpIDFUfoOMYlALCm5ofoiHIiQNRsguRL8IvBx2TbwvYr1abCd4UzXSo-zZCCbUenQrFwXitXOD8sbBrndsiXmIKyQ5GXylwOepsTVwSzGEPGVLJ-OEUHnXLRnP3sJ-j1_u51-ljOnh-eprezUjNgqRSY6Upr1oAWrGpJRQWeEwpd1eGmowCE86rBHIwWgHFnBGvxnFVGAGFg6Am62tSugv8YTUyyt7E1zqnB-DFKIojgjADnGb38hy79GPKH1pRoBG-IwLsp0gCntCaZYhuqDT7GYDq5CrZX4UtikGtLcmtJri3JjaU8dvFTPurezH-HtloyABtA98u_h3d2fgMw_Z5o</recordid><startdate>20230301</startdate><enddate>20230301</enddate><creator>Meucci, Maria Chiara</creator><creator>Stassen, Jan</creator><creator>Tomsic, Anton</creator><creator>Palmen, Meindert</creator><creator>Crea, Filippo</creator><creator>Bax, Jeroen J</creator><creator>Ajmone Marsan, Nina</creator><creator>Delgado, Victoria</creator><general>BMJ Publishing Group Ltd and British Cardiovascular Society</general><general>BMJ Publishing Group 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>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7213-5452</orcidid><orcidid>https://orcid.org/0000-0002-9860-4886</orcidid><orcidid>https://orcid.org/0000-0002-9841-2737</orcidid><orcidid>https://orcid.org/0000-0001-9745-5498</orcidid></search><sort><creationdate>20230301</creationdate><title>Prognostic impact of left ventricular global longitudinal strain in atrial mitral regurgitation</title><author>Meucci, Maria Chiara ; Stassen, Jan ; Tomsic, Anton ; Palmen, Meindert ; Crea, Filippo ; Bax, Jeroen J ; Ajmone Marsan, Nina ; Delgado, Victoria</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b404t-714b5bb490b745c25371d230f5f19f30026659160eb7011fe74c1d45e70240e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Atrial Fibrillation</topic><topic>Cardiology</topic><topic>Cardiovascular disease</topic><topic>echocardiography</topic><topic>Ejection fraction</topic><topic>Female</topic><topic>Global Longitudinal Strain</topic><topic>Heart</topic><topic>Humans</topic><topic>Information systems</topic><topic>Male</topic><topic>Mechanics</topic><topic>Middle Aged</topic><topic>Mitral Valve Insufficiency</topic><topic>Mortality</topic><topic>Patients</topic><topic>Prognosis</topic><topic>Pulmonary arteries</topic><topic>Retrospective Studies</topic><topic>Software</topic><topic>Stroke Volume</topic><topic>Survival analysis</topic><topic>Valvular heart disease</topic><topic>Ventricular Dysfunction, Left</topic><topic>Ventricular Function, Left</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Meucci, Maria Chiara</creatorcontrib><creatorcontrib>Stassen, Jan</creatorcontrib><creatorcontrib>Tomsic, Anton</creatorcontrib><creatorcontrib>Palmen, Meindert</creatorcontrib><creatorcontrib>Crea, Filippo</creatorcontrib><creatorcontrib>Bax, Jeroen J</creatorcontrib><creatorcontrib>Ajmone Marsan, Nina</creatorcontrib><creatorcontrib>Delgado, Victoria</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Heart (British Cardiac Society)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Meucci, Maria Chiara</au><au>Stassen, Jan</au><au>Tomsic, Anton</au><au>Palmen, Meindert</au><au>Crea, Filippo</au><au>Bax, Jeroen J</au><au>Ajmone Marsan, Nina</au><au>Delgado, Victoria</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prognostic impact of left ventricular global longitudinal strain in atrial mitral regurgitation</atitle><jtitle>Heart (British Cardiac Society)</jtitle><stitle>Heart</stitle><addtitle>Heart</addtitle><date>2023-03-01</date><risdate>2023</risdate><volume>109</volume><issue>6</issue><spage>478</spage><epage>484</epage><pages>478-484</pages><issn>1355-6037</issn><eissn>1468-201X</eissn><abstract>ObjectiveLeft atrial (LA) and left ventricular (LV) mechanics are impaired in patients with atrial functional mitral regurgitation (AFMR), but their prognostic value in this subset of patients remains unknown. The present study aimed to evaluate the association between LA and LV longitudinal strain and clinical outcomes in patients with AFMR.MethodsA total of 197 patients (mean age 73±10 years, 44% men) with at least moderate AFMR were retrospectively identified. LV global longitudinal strain (GLS) and left atrial reservoir strain (LAS) were calculated by two-dimensional speckle tracking echocardiography. All-cause mortality was the primary endpoint of the study. The threshold value of LV GLS (≤16.3%) to identify impaired LV mechanics was defined based on the risk excess of the primary endpoint described with a spline curve analysis.ResultsImpaired LV GLS (≤16.3%) was found in 89 (45%) patients. During a median follow-up of 69 months, 45 (23%) subjects experienced the primary endpoint. Patients with impaired LV GLS (≤16.3%) had a significantly lower cumulative survival rate at 5 years, as compared with patients with LV GLS (>16.3%) (74% vs 93%, p<0.001). On multivariable Cox regression analysis, LV GLS expressed as continuous variable was independently associated with the occurrence of all-cause mortality (HR 0.856, 95% CI 0.763 to 0.960; p=0.008) after adjustment for age, LAS, pulmonary artery systolic pressure and severe tricuspid regurgitation. Conversely, LAS was not significantly associated with patients’ outcome.ConclusionsIn patients with significant AFMR, the impairment of LV GLS was independently associated with worse outcomes.</abstract><cop>England</cop><pub>BMJ Publishing Group Ltd and British Cardiovascular Society</pub><pmid>36270784</pmid><doi>10.1136/heartjnl-2022-321698</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-7213-5452</orcidid><orcidid>https://orcid.org/0000-0002-9860-4886</orcidid><orcidid>https://orcid.org/0000-0002-9841-2737</orcidid><orcidid>https://orcid.org/0000-0001-9745-5498</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Aged, 80 and over Atrial Fibrillation Cardiology Cardiovascular disease echocardiography Ejection fraction Female Global Longitudinal Strain Heart Humans Information systems Male Mechanics Middle Aged Mitral Valve Insufficiency Mortality Patients Prognosis Pulmonary arteries Retrospective Studies Software Stroke Volume Survival analysis Valvular heart disease Ventricular Dysfunction, Left Ventricular Function, Left |
| title | Prognostic impact of left ventricular global longitudinal strain in atrial mitral regurgitation |
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