Early Improvement in Left Atrial Remodeling and / Function after Mitral Valve Repair or Replacement in / Organic Symptomatic Mitral Regurgitation Assessed / by Three-Dimensional Echocardiography

ABSTRACT

Left atrial (LA) dilation is associated with worse prognosis in various clinical situationsincluding chronic mitral regurgitation (MR). Real time three-dimensional echocardiography (3DE) hasallowed a better assessment of LA volumes and function. Little is known about LA size and function inearly postoperative period in symptomatic patients with chronic organic MR. We aimed to investigatethese aspects. Methods: By means of 3DE, 43 patients with symptomatic chronic organic MR were prospectivelystudied before and 30 days after surgery (repair or bioprosthetic valve replacement). Twentysubjects were studied as controls. Maximum (Vol-max), minimum, and preatrial contraction LA volumeswere measured and total, passive, and active LA emptying fractions were calculated. Results: Before surgerypatients had higher LA volumes (P < 0.001) but smaller LA emptying fractions than controls(P < 0.01). After surgery there was a reduction in all 3 LA volumes and an increase in active atrial emptyingfraction (AAEF). Multivariate analysis showed that independent predictors of early postoperativeVol-max reduction were preoperative diastolic blood pressure (coefficient = 0.004; P = 0.02), lateralmitral annular early diastolic velocity (e0) (coefficient = 0.023; P = 0.008), and the mean transmitral diastolicgradient increment (coefficient = 0.035; P < 0.001). Furthermore, e0 was also independentlyassociated with AAEF increase (odds ratio = 1.66, P = 0.027). Conclusion: Early LA reverse remodelingand functional improvement occur after successful surgery of symptomatic organic MR regardless ofsurgical technique. Diastolic blood pressure and transmitral mean gradient augmentation are variablesnegatively related to Vol-max reduction. Besides, e0 is positively correlated with both Vol-max reductionand AAEF increase.