Key result
A reduction in mitral regurgitation severity at 6 months after CRT significantly correlated with lower mortality, mediated by an increase in left atrial reservoir strain.
Why the study?
Although CRT improves functional MR severity, the interaction between reduced MR severity and increased LA function, along with its association with outcomes, has not been investigated.
Does an increase in left atrial reservoir strain following cardiac resynchronization therapy reduce all-cause mortality in patients with heart failure and functional mitral regurgitation?
Does an increase in left atrial reservoir strain following cardiac resynchronization therapy reduce all-cause mortality in patients with heart failure and functional mitral regurgitation?
In patients with heart failure and functional mitral regurgitation undergoing CRT, improved survival is driven by an increase in left atrial reservoir strain rather than just a reduction in mitral regurgitation severity alone.
LA reservoir strain gains after CRT were associated with lower mortality in functional MR; extends prognostic marker data but leaves open causal role.
Aims Left atrial (LA) function is a strong prognostic marker in patients with heart failure and functional mitral regurgitation (MR). Although cardiac resynchronization therapy (CRT) has shown to improve MR severity, the interaction between a reduction in MR severity and an increase in LA function, as well as its association with outcomes, has not been investigated. Methods and results LA reservoir strain (RS) was evaluated with speckle tracking echocardiography in patients with at least moderate functional MR undergoing CRT implantation. MR improvement was defined as at least 1 grade improvement in MR severity at 6 months after CRT implantation. The primary endpoint was all-cause mortality. A total of 340 patients (mean age 66 ± 10 years, 73% male) were included, of whom 200 (59%) showed MR improvement at 6 months follow-up. On multivariable analysis, an improvement in MR severity was independently associated with an increase in LARS (odds ratio 1.008; 95% confidence interval 1.003–1.013; P = 0.002). After multivariable adjustment, including baseline and follow-up variables, an increase in LARS was significantly associated with lower mortality. MR improvers showing LARS increasement had the lowest mortality rate, whereas outcomes were not significantly different between MR non-improvers and MR improvers showing no LARS increasement (P = 0.236). Conclusion A significant reduction in MR severity at 6 months after CRT implantation is independently associated with an increase in LARS. In addition, an increase in LARS is independently associated with lower all-cause mortality in patients with heart failure and significant functional MR.
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Stassen et al. (2022) studied this question. A reduction in mitral regurgitation severity at 6 months after CRT significantly correlated with lower mortality, mediated by an increase in left atrial reservoir strain.
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