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Reversibility of left atrium remodeling after surgical correction in patients with valvular heart disease: midterm results

Authors: Averina I.I., Mironenko M.Yu. Glushko L.A., Patsoeva I.M., Bockeria L.A.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

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Type:  Original articles


DOI: https://doi.org/10.24022/1997-3187-2023-17-1-140-152

For citation: Averina I.I., Mironenko M.Yu. Glushko L.A., Patsoeva I.M., Bockeria L.A. Reversibility of left atrium remodeling after surgical correction in patients with valvular heart disease: midterm results. Creative Cardiology. 2023; 17 (1): 140–52 (in Russ.). DOI: 10.24022/1997-3187-2023-17-1-140-152

Received / Accepted:  17.01.2023 / 21.03.2023

Keywords: peak atrial longitudinal strain remodeling left atrium restructuring indexed left atrium volume results after surgical correction of aortic and mitral defects

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Abstract

Objective. To determine the degree of reversibility of left atrium (LA) remodeling in patients after mitral and aortic valve surgery.

Material and methods. 112 patients with (aortic and mitral) valve disease (excluding patients with mitral stenosis) were examined: 90 men and 22 women aged 18 to 72 years, Me=51, Q1–Q3 (35–57). Patients were examined initially before open heart procedure, in 8–14 days and in 12–36 months of follow-up. The main echo parameters were assessed in dynamics: peak atrial longitudinal strain (PALS) LA in the reservoir stage of the LA cycle, indexed LA volume, standard indicators of remodeling and left ventricular (LV) function. After surgery patients were divided into groups: group 1 – control (without complications), group 2 – patients with heart failure (HF) with reduced ejection fraction (HFrEF), group 3 – patients with HF with preserved EF (HFpEF). For comparative analysis the Student's t test (t) for independent samples, the sum of the ranks – according to the Mann–Whitney test (MU) were used.

Results. The indexed volumes of LA differed between the HF groups, however, there were no significant changes within the HF groups in different periods after the operation. In group 1 with a favorable prognosis: the indexed LA volume was 33.6±12 ml/m2 before surgery and 31.12±13.73 ml/m2 after 12 months after surgery (p=0.17); in the HFrEF group – 52±22 ml/m2 and 43.6±10 ml/m2 (p=0.12), in the HFrEF group – 103.07±23 ml/m2 and 89.1±23 ml/m2 (p=0.15). PALS was increased in early and late period after surgery in group with a favorable prognosis (37.52±11.78 at baseline and 42.89±14.78% 12 months after surgery, p=0.07). There was a significant decrease in LA deformation after surgery in HFrEF (16.26±6.5% at baseline and 11.04±5.4% after 12 months, p=0.13). Positive dynamics was noted in the HFpEF group: PALS was 10.37±4.9% at baseline and 20.82±9.5% in a year after surgery (p=0.04).

Conclusion. The initial significantly increased LA volume and decreased PALS without reverse LA structure and function remodeling after MV or AV surgery was typical for patients with postoperative HF development.

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About Authors

  • Irina I. Averina, Dr. Med. Sci., Senior Researcher; ORCID
  • Marina Yu. Mironenko, Cand. Med. Sci., Head of Department; ORCID
  • Lyudmila A. Glushko, Cand. Med. Sci., Head of Department; ORCID
  • Iman M. Patsoeva, Postgraduate; ORCID
  • Leo A. Bockeria, Academician of RAS, President; ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


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