Key result
Predominantly LA remodeling linked to ~72% higher risk of 1-year HF rehospitalization or death.
Why the study?
Patients with rheumatic mitral stenosis exhibit heterogeneous left heart remodeling with unclear impacts on postoperative prognosis, motivating evaluation of the LA to LV volume ratio for classifying remodeling subtypes and predicting postoperative outcomes.
Does a preoperative LA/LV volume ratio >0.61 (predominantly LA remodeling) predict a higher rate of 1-year composite of heart failure rehospitalization and all-cause mortality compared to a ratio ≤0.61 (predominantly LV remodeling) in patients with rheumatic mitral stenosis undergoing mitral valve surgery?
Cohort (n=350)
Does a preoperative LA/LV volume ratio >0.61 (predominantly LA remodeling) predict a higher rate of 1-year composite of heart failure rehospitalization and all-cause mortality compared to a ratio ≤0.61 (predominantly LV remodeling) in patients with rheumatic mitral stenosis undergoing mitral valve surgery?
A preoperative 3D echocardiographic LA/LV volume ratio >0.61 effectively classifies predominantly left atrial remodeling and independently predicts a higher risk of 1-year heart failure rehospitalization and all-cause mortality after mitral valve surgery for rheumatic mitral stenosis.
LA/LV ratio >0.61 was associated with higher 1-year HF events after mitral valve surgery; hypothesis-generating for preoperative risk stratification in rheumatic mitral stenosis.
Background: Rheumatic mitral stenosis (RMS) patients exhibit heterogeneous left heart remodeling, with unclear impacts on postoperative prognosis. This study aimed to classify left heart remodeling subtypes using the left atrial (LA) to left ventricular (LV) volume ratio, analyze subtype differences, and validate the ratio’s predictive value for 1-year postoperative adverse outcomes. Methods: This retrospective study included 350 RMS patients who underwent mitral valve surgery between February 2021 and October 2024. Preoperative LA end-systolic volume (LAESV) and LV end-diastolic volume (LVEDV) were measured by three-dimensional (3D) echocardiography to calculate the LA/LV volume ratio. The optimal cutoff value was determined by receiver operating characteristic (ROC) curve analysis. Patients were divided into predominantly LV remodeling (PLVR) and predominantly LA remodeling (PLAR) groups. Clinical data, echocardiographic parameters, and 1-year adverse outcomes [a composite of heart failure (HF) rehospitalization and all-cause mortality] were compared. Risk factors were identified by univariate and multivariate Cox regression analyses. Results: The LA/LV volume ratio yielded an area under the curve (AUC) of 0.723 (P<0.001) for predicting 1-year adverse outcomes, with an optimal cutoff of 0.61. PLAR patients (LA/LV >0.61, n=168) were older, more frequently female, had a higher prevalence of atrial fibrillation (AF), more severe mitral stenosis, and larger right atrial volume (all P<0.001). PLVR patients (LA/LV ≤0.61, n=182) had a higher rate of ischemic heart disease, lower LV ejection fraction (LVEF), and a higher proportion of moderate-to-severe mitral regurgitation (all P<0.001). The 1-year composite adverse event rate was 20.6% overall, significantly higher in the PLAR group than in the PLVR group (34.3% vs. 15.1%, P<0.001). Multivariate Cox regression identified PLAR [hazard ratio (HR) =1.72, P=0.008], preoperative N-terminal pro-B-type natriuretic peptide (NT-proBNP) >3,000 pg/mL (HR =1.91, P=0.002), New York Heart Association (NYHA) class IV (HR =2.15, P=0.001), moderate-to-severe mitral regurgitation (HR =1.58, P=0.036), and moderate-to-severe tricuspid regurgitation (HR =1.63, P=0.029) as independent risk factors. Conclusions: The LA/LV volume ratio (optimal cutoff 0.61) effectively classifies RMS left heart remodeling subtypes. PLAR is associated with increased 1-year postoperative adverse outcomes, and integrating mitral/tricuspid regurgitation assessment and extended echocardiographic parameters enhances prognostic accuracy. This provides a robust tool for preoperative risk stratification and individualized treatment in RMS patients.
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Jiang et al. (2026) conducted a cohort in Rheumatic mitral stenosis (n=350). Predominantly left atrial remodeling (LA/LV volume ratio >0.61) vs. Predominantly left ventricular remodeling (LA/LV volume ratio ≤0.61) was evaluated on 1-year composite of heart failure rehospitalization and all-cause mortality (HR 1.72, p=0.008). Predominantly left atrial remodeling (LA/LV volume ratio >0.61) increased 1-year HF rehospitalization or death vs predominantly LV remodeling (34.3% vs 15.1%; HR 1.72, P=0.008).
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