The impact of atrial function on mitral regurgitation using three-dimensional transesophageal echocardiography with one-year follow-up

Abstract

Objective To determine whether changes in mitral annular spatial conformation and left atrial (LA) volume are closely related to atrial functional mitral regurgitation (AMR) in patients with atrial fibrillation and before or after the sinus rhythm recovery using real-time three-dimensional transesophageal echocardiography (RT-3D TEE). Methods Fifty-five patients with AMR of at least moderate severity who completed one-year of clinical follow-up after ablation were included in this study. Before ablation and after being followed for one year, intercommissural (IC) and anteroposterior (AP) diameter, annular height (AH) and area (MVA), tenting height (TH) and volume (TV), annular spherical index (ASI), fractional area change of MVA (MVA-FAC), and coaptation index (CPI) were defined and measured by mitral valve quantification software (MVQ). Left atrial volume(LAV), left atrial volume index(LAVI), left atrial area(LAA), left atrial diameter (LAD) and effective regurgitant orifice area (EROA) were also recorded. Results After one year of follow-up, AMR decreased significantly in patients with sinus rhythm [EROA: (0.27±0.03)cm2 vs (0.21±0.04)cm2, P<0.001]. LAA, LAV and LAVI were improved in patients with sinus rhythm[LAA: (22.70±3.34)cm2 vs (18.80±3.45)cm2, LAV: (52.77±5.41)cm2 vs (45.22±6.49)cm2, LAVI: 26.30±3.12 vs 22.98±3.03, all P<0.001]. CPI(β=-0.549, P<0.05), MVA-FAC (β=-0.309, P<0.05) and LAV(β=1.712, P<0.05), MVA-FAC) were independently associated with the reduction in EROA. Conclusions AMR can be decreased through the sinus rhythm recovery and maintenance after ablation, which are caused by improvement of left atrial volume load and leaflets coaptation capability. RT-3D TEE may dynamically assess the changes in leaflets/annular configuration during the AMR follow-up. Key words: Echocardiography, transesophageal, real time three-dimension; Atrial fibrillation; Atrial function, left