Evolution of functional mitral regurgitation and left atrial function in patients receiving cardiac resynchronization therapy

European Heart Journal, vol. 43

Abstract

Abstract Background Left atrial (LA) function is a strong prognostic marker in patients with heart failure and patients with 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 improvement in LA function, as well as their association with outcomes, has not been investigated. Purpose To investigate the association between a reduction in MR severity and an improvement in LA function, as well as their association with outcomes. Methods LA reservoir strain (RS) was evaluated with speckle tracking echocardiography in patients with moderate and severe functional MR. MR improvement was defined as at least 1 grade improvement in MR severity at 6 months after CRT implantation. The association between MR improvement and change in LARS was evaluated using multivariable logistic regression analysis. Patients were dividing into 3 groups: MR non-improvers; MR improvers with no LARS improvement; and MR improvers with LARS improvement. The primary endpoint was all-cause mortality. Results A total of 340 patients (mean age 66±10 years, 73% male) were included, of whom 200 (59%) showed MR improvement after CRT implantation. On multivariable analysis, an improvement in MR was independently associated with an improvement in LARS (OR 1.008; 95% CI 1.003–1.013; p=0.002) (Table 1). MR improvers showing LARS improvement had the lowest mortality rate, whereas outcomes were not significantly different between MR non-improvers and MR improvers showing no LARS improvement (p=0.236) (Figure 1). Conclusion In patients with HF and significant functional MR, an improvement in MR after CRT implantation is independently associated with an improvement in LARS, which in turn, is associated with better survival. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): ESC Training Grant App000064741

Authors 5

1. Jan Stassen Aachen

   Leiden University Medical Center

   Affiliation as printed

   Leiden University Medical Center , Leiden , The Netherlands

2. Xavier Galloo Aachen

   Leiden University Medical Center

   Affiliation as printed

   Leiden University Medical Center , Leiden , The Netherlands

3. Pieter van der Bijl Aachen

   Leiden University Medical Center

   Affiliation as printed

   Leiden University Medical Center , Leiden , The Netherlands

4. Nina Ajmone Marsan Aachen

   Leiden University Medical Center

   Affiliation as printed

   Leiden University Medical Center , Leiden , The Netherlands

5. Jeroen Joost Bax Aachen

   Leiden University Medical Center

   Affiliation as printed

   Leiden University Medical Center , Leiden , The Netherlands