Left atrial remodelling in mitral regurgitation—methodologic approach, physiological determinants, and outcome implications: a prospective quantitative Doppler-echocardiographic and electron beam-computed tomographic study
Abstract
AIMS: To define accurate and normal range of echocardiographic left atrial (LA) volume measurement and to assess the prevalence, determinants, and outcome implications of LA enlargement in mitral regurgitation (MR). METHODS AND RESULTS: We prospectively compared LA volume obtained simultaneously by electron beam-computed tomography (EBCT) and by four echocardiographic methods in 33 test patients. Accurate echocardiographic LA volume measurements were obtained only by biplane area-length method with vertical longitudinal-length (r = 0.95, P < 0.0001; 145 +/- 57 vs. 143 +/- 55 mL, P = 0.57). Using this method, the normal range in 100 normal subjects, the physiological determinants and outcome implications of LA enlargement in 320 patients with organic MR were analysed. In normal subjects, indexed to body surface area, LA index (27 +/- 6 mL/m(2)) was not influenced by age or gender and values > or = 40 mL/m(2) were beyond the upper limit of normal. In MR, the most powerful determinants of LA enlargement were higher regurgitant volume (RVol) and atrial fibrillation (AF) (P < 0.0001), followed by older age, female gender, higher left ventricular end-systolic volume, and mass (all P < 0.001). After diagnosis in sinus rhythm, LA index > or = 40 mL/m(2) predicted superiorly and independently to LA diameter the occurrence of AF [adjusted RR 1.48 (1.06-2.16), P < 0.01] and the combined endpoint of death or need for mitral surgery [adjusted RR 1.61 (1.3-2.0), P < 0.0001]. CONCLUSION: LA remodelling can be accurately assessed by echocardiography and LA index > or = 40 mL/m(2) is beyond the normal range. In organic MR, higher LA index is the combined result of multiple physiological effects, provides independent prognostic information, and therefore should be part of a comprehensive echocardiographic examination.
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Valvular disease and AF interact and sustain each other through volume and pressure overload, tachycardiomyopathy, and neurohumoral factors.
“Similar to heart failure, valvular disease and AF interact and sustain each other through volume and pressure overload, tachycardiomyopathy, and neurohumoral factors.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [264]
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- Authors
- Messika-Zeitoun, D., Bellamy, M., Avierinos, J.-F., Breen, J., Eusemann, C., Rossi, A., Behrenbeck, T., Scott, C., Tajik, J. A., & Enriquez-Sarano, M.
- Affiliations
- Mayo Clinic (US)
- University of Verona (IT)
- Corresponding author
- Enriquez-Sarano, M.
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2007-03-06
- Volume
- 28
- Issue
- 14
- Pages
- 1773-1781
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- OpenAlex
- W2071824807
- Cited by
- 171
- References
- 39
- Citations by year
- 2026: 6 · 2025: 7 · 2024: 7 · 2023: 7 · 2022: 9 · 2021: 9 · 2020: 7 · 2019: 9 · 2018: 10 · 2017: 8 · 2016: 11 · 2015: 4 · 2014: 18 · 2013: 14 · 2012: 9
- FWCI
- 4.62
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r01hl064928-02)
- National Heart, Lung, and Blood Institute (HL-64928)
- National Center for Research Resources (M01RR000585)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Keywords
- left atrial remodeling, mitral regurgitation, left atrial volume, atrial fibrillation, regurgitant volume, left ventricular mass, left ventricular end-systolic volume, electron beam computed tomography, prognosis
- MeSH terms
- Aged, Blood Flow Velocity, Electrocardiography, Female, Heart Atria, Humans, Male, Middle Aged, Mitral Valve Insufficiency, Prospective Studies, Tomography, Emission-Computed, Ultrasonography, Cohort Studies, Atrial Function, Left
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