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Left atrial volume predictive of long-term outcome in patients with organic mitral regurgitation
Le Tourneau T. J Am Coll Cardiol. 2010;56:570-578.
Levine R. J Am Coll Cardiol. 2010;56:579-580.
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Baseline left atrial index strongly and independently predicted survival in patients with organic mitral regurgitation, study findings indicated.
Researchers prospectively enrolled 492 patients (mean age, 63 ± 15 years) in sinus rhythm with organic mitral regurgitation and performed at baseline triple echocardiographic quantitation, which included mitral regurgitation severity, left atrial volume and left ventricular characteristics. They then analyzed the outcome with medical and surgical management.
Left atrial volume indexed to body surface area was 55 ± 26 mL/m² and was independently associated with survival after diagnosis when adjusting for established predictors of outcome (HR=1.3 per 10 mL/m² increment; 95% CI, 1.1-1.5). Patients with left atrial index ≥60 mL/m² had lower 5-year survival than those with no or mild left atrial enlargement (P<.0001). Those with left atrial index ≥60 mL/m² vs. patients with an index <40 mL/m² had increased mortality (HR=2.8; 95% CI, 1.2-6.5) and cardiac events (HR=5.2; 95% CI, 2.6-10.9) with medical management. Additionally, patients who received mitral surgery had lower rates of mortality (HR=0.46; 95% CI, 0.26-0.84) and cardiac events (HR=0.38; 95% CI, 0.23-0.62).
“In organic mitral regurgitation, left atrial index at diagnosis predicts long-term outcome incrementally to known predictors of outcome,” the researchers concluded. “This marker of risk is particularly important because mitral surgery in these patients markedly improves outcome and restores life expectancy. Left atrial index should be measured in routine clinical practice for risk-stratification and for clinical decision-making in patients with organic mitral regurgitation.”
In an accompanying editorial, Robert A. Levine, MD, of Harvard Medical School in Boston, and Stanley Nattel, MD, with the Montreal Heart Institute, wrote on the potential implications of left atrial size in clinical practice.
“Whereas left atrial size is an important predictor of outcome, it may also be a dynamic predictor that reflects the results of appropriate interventions, most notably surgery,” they wrote. “Future studies of the mechanisms linking left atrial enlargement to prognosis may lead to potential approaches that target the left atrial itself to improve outcomes.”
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