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European Journal of Echocardiography Advance Access published online on June 16, 2009
European Journal of Echocardiography, doi:10.1093/ejechocard/jep085
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Left atrial function and deformation in chronic primary mitral regurgitation

Alexander N. Borg*, Keith A. Pearce, Simon G. Williams and Simon G. Ray

Department of Cardiology, Wythenshawe Hospital, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK

Received 15 February 2009; accepted after revision 23 May 2009.

* Corresponding author. Tel: +44 1619987070; fax: +44 1612912389. E-mail address: dr.alex.borg{at}googlemail.com


  Abstract

Aims: To study global and regional left atrial (LA) mechanics in chronic primary mitral regurgitation (MR) with echocardiography.

Methods and results: LA volumes during reservoir, conduit, and contractile phases were measured in 27 MR patients and 25 controls. LA ejection fraction (EF) and ejection force were calculated. Reservoir (SR-R), conduit (SR-C), and contractile phase (SR-A) strain rates, and reservoir phase strain were obtained. LA volumes were higher in MR in all phases. In MR, ejection force was increased (21.5 vs. 12.3 kdynes, P = 0.001); reservoir phase strain (32.91 ± 14.26%), SR-R (2.65 ± 0.87), SR-C (–2.02 ± 0.58), and SR-A (–2.55 ± 1.31 s–1) were increased (23.14 ± 7.96%, 1.62 ± 0.53, –1.29 ± 0.59, –1.98 ± 0.65 s–1, in controls, respectively, P ≤ 0.004). Regional deformation correlated with corresponding volumetric parameters. Despite enhanced SR-A in MR, LA EF was unchanged (31.34 vs. 29.23%, P = ns), and LA contractile tissue velocity (A') was reduced (–5.39 ± 1.95 vs. –6.91 ± 1.80 cm/s, P = 0.006). The LA contractile contribution to left ventricular filling was significantly reduced in MR.

Conclusion: LA deformation is increased in all phases in MR. Unchanged LA EF and reduced A' may reflect the reduced contractile contribution to left ventricular filling.

Keywords: Left atrium; Tissue Doppler; Strain; Strain rate; Mitral regurgitation


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