Impact of preprocedural LA strain on outcome in severe MS

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Abstract Background In patients with mitral stenosis (MS), left atrial (LA) remodeling is crucial for predicting outcomes in severe cases. In this study, we aimed to investigate whether LA longitudinal strain, a parameter of LA remodeling, is associated with adverse outcomes following mitral valve (MV) intervention in patients with severe MS. Methods We included patients with severe MS who underwent percutaneous mitral valvuloplasty (PMV) or MV replacement (MVR) from the long-term registry of Multicenter mitrAl STEnosis with Rheumatic etiology (MASTER) except for previous valvular surgery / intervention or coronary artery bypass surgery, at least moderate other valvular dysfunction, abnormal heart rate (<50 or >100 beats per minute). LA longitudinal strain for each patient was measured on pre-interventional echocardiography, and decreased LA strain was defined as the lower cut-off value on receriver operating characteristics analysis. The primary outcome was defined as all-cause mortality. Results Among 505 patients over a mean follow-up of 6.8 ± 4.9 years after MV intervention, 27 (5.3%) patients had experienced primary outcomes. Patients with decreased LA strain were older (61.1 ± 11.6 vs. 58.2 ±12.1 years, p=0.007), had more atrial fibrillation (97.6 vs. 79.5%, p<0.001), underwent more MVR (89.4 vs. 82.8%, p=0.038), had higher mean diastolic pressure gradient (MDPG) and right ventricular systolic pressure, had lower left ventricular ejection fraction, and larger LA. Patients with decreased LA strain (< 12.2%) revealed a poorer outcome than those with preserved LA strain (log-rank p<0.001) (Figure 1). Conclusions Decreased LA strain on pre-interventional echocardiography was associated with an increased risk of all-cause death after MV intervention. Further prospective studies would be warranted to establish the risk stratification of MV intervention in patients with severe MS. Figure 1. Kaplan-Meier analysis for primary outcomes according to the cut-off value of LA longitudinal strain in patients with severe MS.