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Left atrial mechanics in moderate mitral valve disease: earlier markers of damage

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Abstract

While the impairment of left atrial (LA) mechanics in mitral valve disease is well known, the exact onset of reservoir, conduit, and contractile dysfunction in mitral stenosis (MS) and mitral regurgitation (MR) remains unclear. We aimed to clarify the LA deformation mechanics in patients with moderate mitral valve disease. We conducted a prospective observational study of 80 patients with moderate isolated MR, 80 patients with moderate isolated MS, and 64 age-matched controls without mitral valve disease. Strain (ɛ) and strain rate (SR) on speckle tracking echocardiography were assessed as indicators of LA and right atrium (RA) reservoir (ɛsys, SRs), conduit (ɛe, SRe), and contractile (ɛa, SRa) functions. Conventional echocardiographic parameters of the left ventricle (LV) were also assessed. Comparisons were conducted according to mitral valve pathology (MR patients, MS patients, controls). The mean LV ejection fraction, end-diastolic diameter, and global longitudinal strain did not differ across the groups. The pulmonary artery systolic pressure, LA volume indexed to body surface area, and LA mechanics were significantly impaired in mitral valve disease (patients vs controls). While LA ɛ did not vary between MR and MS, MR patients had better LA SRs and SRe but worse SRa (p < 0.01). SRe > − 0.65% had higher specificity for MS, with an area under the curve of 0.85 (p < 0.01). RA mechanics were significantly impaired in mitral valve disease (patients vs controls) but did not vary significantly with disease pathology (MS vs MR). Patients with moderate mitral valve disease exhibit early and pathology-specific changes in the LA deformation mechanics, manifesting mainly as impaired contractile-phase SR in MR and impaired conduit-phase SR in MS. Our findings highlight SR as a potentially useful early marker of LA dysfunction in relation to mitral valve disease.

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Abbreviations

CI:

Confidence interval

ɛ:

Strain

LA:

Left atrium

LAVi:

Left atrial volume (indexed to the body surface area)

LA-ɛsys:

Left atrial systolic strain (reservoir function)

LA-ɛe:

Left atrial early diastolic strain (conduit function)

LA-ɛa:

Left atrial late diastolic strain (contractile function)

LA-SRs:

Left atrial systolic strain rate (reservoir function)

LA-SRe:

Left atrial early diastolic strain rate (conduit function)

LA-SRa:

Left atrial late diastolic strain (contractile function)

LV-GLS:

Left ventricular global longitudinal strain

LVDD:

Left ventricular end-diastolic diameter

LVSD:

Left ventricular end-systolic diameter

LVEF:

Left ventricular ejection fraction

MR:

Mitral regurgitation

MS:

Mitral stenosis

MV:

Mitral valve

PASP:

Pulmonary artery systolic pressure

RA:

Right atrium

RAVi:

Right atrial volume (indexed)

RA-ɛsys:

Right atrial systolic strain (reservoir function)

RA-ɛe:

Right atrial early diastolic strain (conduit function)

RA-ɛa:

Right atrial late diastolic strain (contractile function)

RA-SRs:

Right atrial systolic strain rate (reservoir function)

RA-SRe:

Right atrial early diastolic strain rate (conduit function)

RA-SRa:

Right atrial late diastolic strain (contractile function)

RV:

Right ventricle

SR:

Strain rate

STE:

Speckle-tracking echocardiography

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Funding

This study did not receive any specific funding.

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Authors and Affiliations

  1. Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, 3000-001, Coimbra, Portugal

    Patrícia Marques-Alves, Ana Vera Marinho, Célia Domingues, Rui Baptista, Graça Castro, Rui Martins & Lino Gonçalves

  2. ICBR Coimbra Institute for Clinical and Biomedical Research, Universidade de Coimbra, Coimbra, Portugal

    Rui Baptista & Lino Gonçalves

  3. Faculty of Medicine, Universidade de Coimbra, Coimbra, Portugal

    Patrícia Marques-Alves, Rui Baptista & Lino Gonçalves

Authors
  1. Patrícia Marques-Alves
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  2. Ana Vera Marinho
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  3. Célia Domingues
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  4. Rui Baptista
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  5. Graça Castro
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  6. Rui Martins
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  7. Lino Gonçalves
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Correspondence to Patrícia Marques-Alves.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Marques-Alves, P., Marinho, A.V., Domingues, C. et al. Left atrial mechanics in moderate mitral valve disease: earlier markers of damage. Int J Cardiovasc Imaging 36, 23–31 (2020). https://doi.org/10.1007/s10554-019-01683-w

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  • DOI: https://doi.org/10.1007/s10554-019-01683-w

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