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Left atrium reservoir function is central in patients with rheumatic mitral stenosis

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Abstract

We investigated the relationship between Left Atrium strain reservoir function and symptoms and its impact on modulating Left Ventricular mechanics, diastolic filling, stroke volume, mean trans-mitral gradient and pulmonary pressure in mitral stenosis (MS) patients. We examined 195 full spectrum MS patients which were divided into two groups: Group 1 (n = 109) included patients with NYHA I & II functional class and group 2 (n = 86) included patients with NYHA III & IV functional class. LA strain reservoir function and classical echocardiographic parameters were calculated. LASr was significantly higher in group 1 versus group 2 in patients with MVA ≤ 1cm2 [8.8(6.0–12.6) vs 6.8(4.1–8.9), p = 0.03) and when 1cm2 < MVA ≤ 1.5 cm2 [10.0 (5.4–13.8) vs 6.7(4.5–9.0), p = 0.02). In patients with Pulmonary Hypertension, group 1 had significantly higher LASr than group 2 [11.1(6.6–14.8) vs 5.9(4.3–9.0), p = 0.002) By multivariate analysis, diabetes (OR = 4.11, 95%CI: 1.6–10.4), stroke (OR = 2.9, 95%CI: 1.1–7.9), LASr (OR = 0.9, 95%CI: 0.80–0.99) and LV ejection fraction (LVEF)(OR = 0.9, 95%CI: 0.91–0.99) were independently associated with NYHA functional class. LASr was significantly and positively correlated to MVA (r = 0.3, p < 10–3), stroke volume (r = 0.25, p = 10–3), mitral inflow (r = 0.4, p < 10–3) and LVEF(r = 0.14, p = 0.05). It was significantly and negatively correlated to left ventricular strain (r = −0.65, p < 10–3), LA indexed volume (r = −0.40, p < 10–3), maximum tricuspid regurgitation velocity (r = −0.25, p = 0.003), MTMG (r = −0.25, p = 10–3), and heart rate (r = −0.4, p < 10–3). We demonstrated a large range of interaction between LASr and mitral valve echocardiographic parameters. This may explain the reasons we identified LASr as an independent factor for MS functional tolerance.

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Data availability

The data underlying this article will be shared on reasonable request to the corresponding author.

Abbreviations

LASr:

Left Atrium Strain Reservoir Function

LVS:

Left Ventricular Strain

MS:

Mitral Stenosis

MTMG:

Mean Trans-Mitral Gradient

TRVmax:

Tricuspid Regurgitation Velocity max

MVA:

Mitral Valve Area

PTMC:

Percutaneous Transvenous Mitral Commissurotomy

PH:

Pulmonary Hypertension

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The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Cardiology A Department, University of Monastir, Research Laboratory LR12 SP 16 Fattouma Bourguiba University Hospital, Rue du 1er juin 1955, 5000, Monastir, Tunisia

    Nidhal Bouchahda, Mohamed Yassine Kallala, Mejdi Ben Messaoud, Mehdi Boussaada, Ghada Sassi, Marwa Jarraya, Marwen Mahjoub, Majed Hassine, Fethi Betbout & Habib Gamra

  2. Department of Preventive Medicine, Faculty of Medicine, University of Monastir, Rue. Avicenne, 5019, Monastir, Tunisia

    Imen Zemni

  3. Cardiology Department, University Hospital Tahar Sfar, 5100, Mahdia, Tunisia

    Taha Hasnaoui & Hassen Haj Amor

Authors
  1. Nidhal Bouchahda
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by [BN], [MYK] and [IZ]. The first draft of the manuscript was written by [NB] and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Nidhal Bouchahda.

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The authors have no relevant financial or non-financial interests to disclose.

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This is an observational study. The Fattouma Bourguiba Research Ethics Committee has approved this study.

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Informed consent was obtained from all individual participants included in the study.

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Bouchahda, N., Kallala, M.Y., Zemni, I. et al. Left atrium reservoir function is central in patients with rheumatic mitral stenosis. Int J Cardiovasc Imaging 38, 1257–1266 (2022). https://doi.org/10.1007/s10554-021-02509-4

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