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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.

References

  1. Upadhya B., Kitzman D.W. Heart failure with preserved ejection fraction: new approaches to diagnosis and management. Clin. Cardiol. 2020; 43 (2): 145–55. DOI: 10.1002/clc.23321
  2. Mandoli G.E., Sisti N., Mondillo S., Cameli M. Left atrial strain in left ventricular diastolic dysfunction: have we finally found the missing piece of the puzzle? Heart Fail. Rev. 2020; 25 (3): 409–17. DOI: 10.1007/s10741-019-09889-9
  3. Freed B.H., Daruwalla V., Cheng J.Y., Aguilar F.G., Beussink L., Choi A. et al. Prognostic utility and clinical significance of cardiac mechanics in heart failure with preserved ejection fraction: importance of left atrial strain. Circ. Cardiovasc. Imaging. 2016; 9 (3). DOI: 10.1161/circimaging.115.003754
  4. Casaclang-Verzosa G., Gersh B.J., Tsang T.S. Structural and functional remodeling of the left atrium: clinical and therapeutic implications for atrial fibrillation. J. Am. Coll. Cardiol. 2008; 51: 1–11. DOI: 10.1016/j.jacc.2007.09.026
  5. Barger P.M., Kelly D.P. Fatty acid utilization in the hypertrophied and failing heart: molecular regulatory mechanisms. Am. J. Med. Sci. 1999; 318: 36–42. DOI: 10.1097/00000441-199907000-00006
  6. Burstein B., Libby E., Calderone A., Nattel S. Differential behaviors of atrial versus ventricular fibroblasts: a potential role for platelet-derived growth factor in atrial-ventricular remodeling differences. Circulation. 2008; 117: 1630–41. DOI: 10.1161/CIRCULATIONAHA.107.748053
  7. Kumagai K., Nakashima H., Urata H., Gondo N., Arakawa K., Saku K. Effects of angiotensin II type 1 receptor antagonist on electrical and structural remodeling in atrial fibrillation. J. Am. Coll. Cardiol. 2003; 41: 2197–204. DOI: 10.1016/S0735-1097(03)00464-9
  8. Triposkiadis F., Pieske B., Butler J., Parissis J., Giamouzis G., Skoularigis J. et al. Global left atrial failure in heart failure. Eur. J. Heart Fail. 2016; 18: 1307–20. DOI: 10.1002/ejhf.64
  9. Psychari S.N., Apostolou T.S., Sinos L., Hamodraka E., Liakos G., Kremastinos D.T. Relation of elevated C-reactive protein and interleukin-6 levels to left atrial size and duration of episodes in patients with atrial fibrillation. Am. J. Cardiol. 2005; 95: 764–7. DOI: 10.1016/j.amjcard.2004.11.032 10. Chung M.K., Martin D.O., Sprecher D., Wazni O., Kanderian A., Carnes C.A. et al. C-reactive protein elevation in patients with atrial arrhythmias: inflammatory mechanisms and persistence of atrial fibrillation. Circulation. 2001; 104: 2886–91. DOI: 10.1161/hc4901.101760
  10. Patel D.A., Lavie C.J., Milani R.V., Ventura H.O. Left atrial volume index predictive of mortality independent of left ventricular geometry in a large clinical cohort with preserved ejection fraction. Mayo Clin. Proc. 2011; 86 (8): 730–7. DOI: 10.4065/mcp.2010.0682
  11. Freed B.H., Daruwalla V., Cheng J.Y., Aguilar F.G., Beussink L., Choi A. et al. Prognostic utility and clinical significance of cardiac mechanics in heart failure with preserved ejection fraction: importance of left atrial strain. Circ. Cardiovasc. Imaging. 2016; 9 (3). DOI: 10.1161/CIRCIMAGING.115.003754
  12. Cameli M., Lisi M., Righini F.M., Massoni A., Natali B., Focardi M. et al. Usefulness of atrial deformation analysis to predict left atrial fibrosis and endocardial thickness in patients undergoing mitral valve operations for severe mitral regurgitation secondary to mitral valve prolapse. Am. J. Cardiol. 2013; 111: 595–601. DOI: 10.1016/j.amjcard.2012.10.049
  13. Freed B.H., Daruwalla V., Cheng J.Y., Aguilar F.G., Beussink L., Choi A. et al. Prognostic utility and clinical significance of cardiac mechanics in heart failure with preserved ejection fraction: importance of left atrial strain. Circ. Cardiovasc. Imaging. 2016; 9 (3). DOI: 10.1161/CIRCIMAGING.115.003754
  14. Tops L.F., Delgado V., Bertini M., Marsan N.A., Den Uijl D.W., Trines S.A. et al. Left atrial strain predicts reverse remodeling after catheter ablation for atrial fibrillation. J. Am. Coll. Cardiol. 2011; 57: 324–31. DOI: 10.1016/j.jacc.2010.05.063
  15. Kokubu N., Yuda S., Tsuchihashi K., Hashimoto A., Nakata T., Miura T. et al. Noninvasive assessment of left atrial function by strain rate imaing in patients with hypertension: a possible beneficial effect of renin-angiotensin system inhibition on left atrial function. Hypertens Res. 2007; 30: 13–21. DOI: 10.1291/hypres.30.13
  16. Nakashima H., Kumagai K., Urata H., Gondo N., Ideishi M., Arakawa K. Angiotensin II antagonist prevents electrical remodeling in atrial fibrillation. Сirculation. 2000; 101: 2612–7. DOI: 10.1161/01.cir.101.22.2612
  17. Mattioli A.V., Bonatti S., Monopoli D., Zennaro M., Mattioli G. Influence of regression of left ventricular hypertrophy on left atrial size and function in patients with moderate hypertension. Blood Press. 2005; 14: 273–8. DOI: 10.1080/08037050500235523
  18. Tops L.F., Bax J.J., Zeppenfeld K., Jongbloed M.R., van der Wall E.E., Schalij M.J. Effect of radiofrequency catheter ablation for atrial fibrillation on left atrial cavity size. Am. J. Cardiol. 2006; 97: 1220–2. DOI: 10.1016/j.amjcard.2005.11.043
  19. Bax J.J., Marsan N.A., Delgado V. Non-invasive imaging in atrial fibrillation: focus on prognosis and catheter ablation. Heart. 2015; 101: 94–100. DOI: 10.1136/heartjnl-2013-305150
  20. Marsan N.A., Tops L.F., Holman E.R., Van de Veire N.R., Zeppenfeld K., Boersma E. et al. Comparison of left atrial volumes and function by realtime three-dimensional echocardiography in patients having catheter ablation for atrial fibrillation with persistence of sinus rhythm versus recurrent atrial fibrillation three months later. Am. J. Cardiol. 2008; 102: 847–53. DOI: 10.1016/j.amjcard.2008.05.048
  21. Ring L., Rana B.S., Wells F.C. Atrial function as a guide to timing of intervention in mitral valve prolapse with mitral regurgitation. J. Am. Coll. Cardiol. Img. 2014; 7 (3): 225–32. DOI: 10.1016/j.jcmg.2013.12.009
  22. Cameli M., Mandoli G.E., Loiacono F., Dini F.L., Henein M., Mondillo S. Left atrial strain: a new parameter for assessment of left ventricular filling pressure. Heart Fail. Rev. 2016; 21 (1): 65–76. DOI: 10.1007/s10741-015-9520-9
  23. Jenner J., Ilami A., Petrini J., Eriksson P., FrancoCereceda A., Eriksson M.J., Caidahl K. Pre- and postoperative left atrial and ventricular volumetric and deformation analyses in severe aortic regurgitation. Cardiovasc. Ultrasound. 2021; 19 (1): 14. DOI: 10.1186/s12947-021-00243-4

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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