Left atrial volume index as an independent determinant of pulmonary hypertension in patients with chronic organic mitral regurgitation.

Nithima Ratanasit,Khemajira Karaketklang,Rungroj Krittayaphong

doi:10.1186/s12872-016-0306-3

Nithima Ratanasit, Khemajira Karaketklang + Show 1 more

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https://doi.org/10.1186/s12872-016-0306-3

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Abstract

BackgroundThe common pathophysiological consequences of chronic mitral regurgitation (MR) are left atrial (LA) remodeling/dilatation and pulmonary hypertension (PH). We aimed to study the association between LA volume (LAV) and PH in patients with chronic organic MR.MethodsWe prospectively studied 154 patients (age 55.0 ± 16.4 years, 39.6 % female) with isolated moderate to severe chronic organic MR. Severity of MR was assessed using proximal isovelocity surface area method. LAV was assessed using the area-length biplane method. PH was defined as pulmonary artery systolic pressure > 50 mmHg.ResultsRuptured chordae and flail leaflets were the most common etiology of MR (53.2 %). Severe MR (effective regurgitant orifice area (EROA) > 40 mm2) was described in 123 (79.9 %) patients. Dyspnea, history of heart failure and atrial fibrillation was reported in 37.7 %, 20.1 % and 29.4 % of patients, respectively. Left ventricular (LV) ejection fraction was 68.1 ± 5.9 %. LAV index and EROA were 67.1 (24.7–391.3) ml/m2and 60.3 (10.5–250.9) mm2, respectively. Age, presence of atrial fibrillation, EROA, LV end-systolic and end-diastolic volume, LV mass index, LAV index and tricuspid annular plane systolic excursion were all factors univariately associated with PH. In multiple logistic regression analysis, age (OR = 1.03, 95 % CI: 1.001-1.06, p = 0.04), EROA (OR = 1.02, 95 % CI: 1.003-1.03, p = 0.017) and LAV index (OR = 1.01, 95 % CI: 1.002-1.02, p = 0.021) were independently associated with PH.ConclusionsIn patients with chronic organic MR, a significant association exists between LAV index and PH. Age, the severity of MR as assessed by EROA, and LAV index are the independent determinants of PH.

Highlights

The common pathophysiological consequences of chronic mitral regurgitation (MR) are left atrial (LA) remodeling/dilatation and pulmonary hypertension (PH)
Patients excluded from the study were those with insignificant MR (EROA < 20 mm2), combined mitral valve disease of significant degree, functional/ischemic MR, previous percutaneous balloon mitral valvotomy, associated significant aortic valve disease, prosthetic valve at any position, previous cardiac or valve surgery, left ventricular (LV) systolic dysfunction (LV ejection fraction < 50 %), congenital or pericardial disease, renal dysfunction, pulmonary or hepatic disease and those with limited or poor-quality echocardiographic study
31.2 %, 5.2 % and 1.3 % were in New York Heart Association functional class II, III and IV, respectively

Summary

Introduction

The common pathophysiological consequences of chronic mitral regurgitation (MR) are left atrial (LA) remodeling/dilatation and pulmonary hypertension (PH). We aimed to study the association between LA volume (LAV) and PH in patients with chronic organic MR. Mitral stenosis and mitral regurgitation (MR), remain a common health problem worldwide. The typical pathophysiological consequences of mitral valve diseases, regardless of the etiologies, are left atrial (LA) dilatation and pulmonary hypertension (PH). LA volume (LAV) is an accurate cardiovascular risk marker in patients with organic MR in predicting adverse outcomes [6,7,8]. Recent guidelines emphasize the clinical importance of PH, defined as pulmonary artery systolic pressure > 50 mmHg, in asymptomatic patients with chronic severe MR as an indication for early mitral valve

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