JACC. Cardiovascular imaging · 2026
Integrated Atrial and Ventricular Strain Assessment in Patients With Severe Degenerative Mitral Regurgitation Undergoing Surgery.
СтатьяВалидационное исследованиеНазвание и аннотация: Перевод в очереди
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Oh Jin Kyung, Kwak Soongu, Park Chan Soon, Sun Byung Joo, Lee Sahmin, Park Jun-Bean, Kim Hyung-Kwan, Kim Yong-Jin, Song Jong-Min, Kang Duk-Hyun, Song Jae-Kwan, Park Jae-Hyeong, Cho Goo-Yeong, Lee Seung-Pyo, Kim Dae-Hee
Аннотация
BACKGROUND: Current guidelines for degenerative mitral regurgitation (MR) emphasize left ventricular (LV) dysfunction. However, subclinical alterations in left atrial (LA) or LV strain may manifest earlier in severe MR.
OBJECTIVES: This study sought to determine whether combined LA and LV strain measurements improve long-term mortality prediction in severe degenerative MR, especially in asymptomatic individuals.
METHODS: This retrospective derivation cohort included 1,314 patients (mean age: 55 ± 13 years; 35% women) who underwent valve repair or replacement for severe MR. Preoperative peak atrial longitudinal strain (PALS) and LV-global longitudinal strain (GLS) were measured. Patients were categorized into 4 groups by using spline-derived thresholds (PALS: <21.4%; LV-GLS: >-20.5%). The primary outcome was all-cause mortality (median follow-up, 8.4 years). External validation included 605 independent patients.
RESULTS: Impaired PALS (adjusted HR [aHR]: 2.11; P < 0.001) and impaired LV-GLS (aHR: 1.66; P = 0.008) were independently associated with high mortality. The group with both impaired PALS and LV-GLS demonstrated the worst outcome (aHR: 2.50; P < 0.001). In asymptomatic patients (n = 900), the combined use of both strain parameters outperformed traditional LV dysfunction criteria (LV ejection fraction ≤60% or LV end-systolic dimension ≥40 mm), thereby significantly improving net reclassification (net reclassification index = 0.436; P < 0.001) and discrimination (integrated discrimination improvement = 0.024; P = 0.003). Subgroup analyses demonstrated that the prognostic contribution of each strain parameter varied by the functional status of the other chamber. External validation confirmed these associations.
CONCLUSIONS: Concomitant impairment of both PALS and LV-GLS identified patients at the highest mortality risk. These findings support an integrated atrial-ventricular strain assessment to improve prognostic stratification, particularly in asymptomatic patients with severe degenerative MR who are undergoing MV surgery.
OBJECTIVES: This study sought to determine whether combined LA and LV strain measurements improve long-term mortality prediction in severe degenerative MR, especially in asymptomatic individuals.
METHODS: This retrospective derivation cohort included 1,314 patients (mean age: 55 ± 13 years; 35% women) who underwent valve repair or replacement for severe MR. Preoperative peak atrial longitudinal strain (PALS) and LV-global longitudinal strain (GLS) were measured. Patients were categorized into 4 groups by using spline-derived thresholds (PALS: <21.4%; LV-GLS: >-20.5%). The primary outcome was all-cause mortality (median follow-up, 8.4 years). External validation included 605 independent patients.
RESULTS: Impaired PALS (adjusted HR [aHR]: 2.11; P < 0.001) and impaired LV-GLS (aHR: 1.66; P = 0.008) were independently associated with high mortality. The group with both impaired PALS and LV-GLS demonstrated the worst outcome (aHR: 2.50; P < 0.001). In asymptomatic patients (n = 900), the combined use of both strain parameters outperformed traditional LV dysfunction criteria (LV ejection fraction ≤60% or LV end-systolic dimension ≥40 mm), thereby significantly improving net reclassification (net reclassification index = 0.436; P < 0.001) and discrimination (integrated discrimination improvement = 0.024; P = 0.003). Subgroup analyses demonstrated that the prognostic contribution of each strain parameter varied by the functional status of the other chamber. External validation confirmed these associations.
CONCLUSIONS: Concomitant impairment of both PALS and LV-GLS identified patients at the highest mortality risk. These findings support an integrated atrial-ventricular strain assessment to improve prognostic stratification, particularly in asymptomatic patients with severe degenerative MR who are undergoing MV surgery.
Предметные рубрики MeSH
HumansFemaleMiddle AgedMitral Valve InsufficiencyGlobal Longitudinal StrainAtrial Function, LeftRetrospective StudiesPredictive Value of TestsSeverity of Illness IndexVentricular Function, LeftMaleRisk FactorsTime FactorsAgedTreatment OutcomeMitral ValveVentricular Dysfunction, LeftAdultHeart Valve Prosthesis ImplantationRisk AssessmentAsymptomatic DiseasesReproducibility of Results