Interaction between secondary mitral regurgitation and left atrial function and their prognostic implications after cardiac resynchronization therapy

European Heart Journal - Cardiovascular Imaging, vol. 24, pp. 532–541

Abstract

AIMS: Left atrial (LA) function is a strong prognostic marker in patients with heart failure and functional mitral regurgitation (MR). Although cardiac resynchronization therapy (CRT) has shown to improve MR severity, the interaction between a reduction in MR severity and an increase in LA function, as well as its association with outcomes, has not been investigated. METHODS AND RESULTS: LA reservoir strain (RS) was evaluated with speckle tracking echocardiography in patients with at least moderate functional MR undergoing CRT implantation. MR improvement was defined as at least 1 grade improvement in MR severity at 6 months after CRT implantation. The primary endpoint was all-cause mortality. A total of 340 patients (mean age 66 ± 10 years, 73% male) were included, of whom 200 (59%) showed MR improvement at 6 months follow-up. On multivariable analysis, an improvement in MR severity was independently associated with an increase in LARS (odds ratio 1.008; 95% confidence interval 1.003-1.013; P = 0.002). After multivariable adjustment, including baseline and follow-up variables, an increase in LARS was significantly associated with lower mortality. MR improvers showing LARS increasement had the lowest mortality rate, whereas outcomes were not significantly different between MR non-improvers and MR improvers showing no LARS increasement (P = 0.236). CONCLUSION: A significant reduction in MR severity at 6 months after CRT implantation is independently associated with an increase in LARS. In addition, an increase in LARS is independently associated with lower all-cause mortality in patients with heart failure and significant functional MR.

Authors 6

1. Jan Stassen Aachen Department of Cardiology, Leiden University Medical Center

   Leiden University Medical Center · Jessa Hospital

   Affiliation as printed

   Department of Cardiology, Jessa Hospital , Stadsomvaart 11, 3500 Hasselt , Belgium

   Department of Cardiology, Leiden University Medical Center , Albinusdreef 2, 2300 RC Leiden , The Netherlands

2. Xavier Galloo Aachen Department of Cardiology, Leiden University Medical Center

   Leiden University Medical Center · Universitair Ziekenhuis Brussel

   Affiliation as printed

   Department of Cardiology, Leiden University Medical Center , Albinusdreef 2, 2300 RC Leiden , The Netherlands

   Department of Cardiology, Universitair Ziekenhuis Brussel , Laarbeeklaan 101, 1090 Brussels , Belgium

3. Pieter van der Bijl Aachen Department of Cardiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiology, Leiden University Medical Center , Albinusdreef 2, 2300 RC Leiden , The Netherlands

4. Martin B. Leon

   Columbia University Irving Medical Center · Cardiovascular Research Foundation

   Affiliation as printed

   Department of Cardiology, Columbia University Irving Medical Center/Presbyterian Hospital and Cardiovascular Research Foundation , New York, NY 10032 , USA

5. Nina Ajmone Marsan Aachen Department of Cardiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiology, Leiden University Medical Center , Albinusdreef 2, 2300 RC Leiden , The Netherlands

6. Jeroen Joost Bax corresponding Aachen Department of Cardiology, Leiden University Medical Center

   University of Turku · Leiden University Medical Center · Turku University Hospital

   Affiliation as printed

   Department of Cardiology, Leiden University Medical Center , Albinusdreef 2, 2300 RC Leiden , The Netherlands

   Turku Heart Center, University of Turku and Turku University Hospital , Kiinamyllynkatu 4-8, FI-20520 Turku , Finland