What is the clinical evidence from this study?

Study design: Observational. Population: Severe mitral valve disease (mitral stenosis or regurgitation) (n=50). Intervention: Speckle tracking echocardiography (Left atrial global strain) vs. Histopathology (Degree of left atrial fibrosis). Primary outcome: Correlation between left atrial global strain and degree of left atrial fibrosis (B=-1.37, 95% CI -2.32 - -0.41, p=0.006).

January 1, 2012Open Access

Prediction of Left Atrial Fibrosis With Speckle Tracking Echocardiography in Mitral Valve Disease: A Comparative Study With Histopathology

Key Result

Left atrial global strain measured by speckle tracking echocardiography was significantly and independently correlated with the degree of left atrial fibrosis in patients with severe mitral valve disease.

Study Design

Type

Observational (n=50)

Multicenter

Structured PICO

Does preoperative left atrial strain measured by speckle tracking echocardiography predict the degree of left atrial fibrosis in patients with severe mitral valve disease?

Population

50 patients scheduled for mitral valve (MV) surgery due to severe MV stenosis (n=28) or regurgitation (n=22), mean age 56, 54% female, in Korea. Key exclusions: previous MV replacement or repair, concomitant severe aortic valve disease, congenital heart disease, coronary artery disease, chronic liver/renal disease, and uncontrolled thyroid disease.

Intervention

Preoperative left atrial (LA) strain measured by 2D speckle tracking echocardiography

Comparator

Histopathology (degree of LA interstitial fibrosis from tissue obtained during surgery) as the reference standard

Outcome

Correlation between preoperative LA global strain and the degree of LA interstitial fibrosis measured by histopathologysurrogate

Preoperative left atrial global strain measured by speckle tracking echocardiography is a useful non-invasive predictor of left atrial interstitial fibrosis in patients with severe mitral valve disease.

Main Result

Effect estimate: B=-1.37 (95% CI -2.32 - -0.41)

p-value: p=0.006

Limitations

Small number of patients with heterogeneous characteristics
Limited long-term follow-up data
Difficulty in obtaining an accurate ROI close enough to the effective shape of the left atrium
Risk of contamination by signal components arising from structures surrounding the left atrium
Used software designed for left ventricular analysis to assess the left atrial strain
Only longitudinal function variables were evaluated

Abstract

BACKGROUND AND OBJECTIVES: Left atrial (LA) fibrosis is a main determinant of LA remodeling and development of atrial fibrillation. However, non-invasive prediction of LA fibrosis is challenging. We investigated whether preoperative LA strain as measured by speckle tracking echocardiography could predict the degree of LA fibrosis and LA reverse remodeling after mitral valve (MV) surgery. SUBJECTS AND METHODS: Speckle tracking echocardiography and LA volume measurements were performed in 50 patients one day before MV surgery. LA tissues were obtained during the surgery, and the degrees of their interstitial fibroses were measured. LA volume measurements were repeated within 30 days after surgery (n=50) and 1-year later (n=39). RESULTS: Left atrial global strain was significantly correlated with the degree of LA fibrosis (r=-0.55, p<0.001), and its correlation was independent of age, underlying rhythm, presence of rheumatic heart disease and type of predominant MV disease (B=-1.37, 95% confidence interval -2.32 - -0.41, p=0.006). The degree of LA fibrosis was significantly correlated with early (r=-0.337, p=0.017) and 1-year (r=-0.477, p=0.002) percent LA volume reduction after MV surgery, but LA global strain was not significant. CONCLUSION: Left atrial strain as measured by speckle tracking echocardiography might be helpful for predicting the degree of LA fibrosis in patients with MV disease.

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