Effect of atenolol therapy on left atrial appendage function in patients with symptomatic mitral stenosis

Abstract

Exercise capacity is frequently impaired in patients with mitral stenosis (MS).1 In several studies, it has been shown that β-blocker therapy significantly improved exercise capacity in patients with isolated MS with sinus rhythm who became symptomatic after exercise.2–4 Beta-adrenergic blocking agents reduce the diastolic pressure gradient across the stenotic mitral valve, and thus, pulmonary congestion, by decreasing both heart rate and cardiac output.5 Despite their beneficial effects, however, β blockers are known to have some adverse effects. It has been suggested that the negative inotropic effects of β-adrenergic blockers, by depressing cardiac performance and thus increasing left ventricular end-diastolic pressure, may counteract the beneficial effects.5,6 Therefore, theoretically, β blockers may have harmful effects on the left atrial appendage (LAA) function in patients with symptomatic pure MS with sinus rhythm. The effect of β blockade on the LAA in patients with pure MS with sinus rhythm has not been documented. We examined the effect of β-blocker therapy on LAA function in patients with symptomatic isolated MS with sinus rhythm.