In pediatric patients with isolated MVP, left atrial longitudinal reservoir strain was independently associated with LVEF (β=0.529; 95% CI 0.192-0.866), and LACI was higher in those with clinical events.
Case-Control (n=40)
Do CMR-derived strain parameters and left atrioventricular coupling index (LACI) correlate with clinical events in pediatric patients with isolated mitral valve prolapse and moderate mitral regurgitation?
CMR-derived strain parameters and LACI can identify left atrioventricular dyssynchrony and are associated with clinical events like arrhythmias in pediatric patients with isolated MVP and moderate MR.
Effect estimate: β=0.529 (95% CI 0.192 to 0.866)
Abstract Background Recent insights indicate that the pathological changes associated with isolated mitral valve prolapse (MVP) may include myocardial fibrosis, which is linked to arrhythmias, and sudden cardiac death. In the past few years, it has become clear that cardiovascular magnetic resonance (CMR) has distinct advantages in detecting mitral valve abnormalities, as well as assessing myocardial tissue characteristics. Even with preserved left ventricular (LV) systolic function, left atrial (LA) dysfunction can negatively impact overall heart performance. The lack of coordination between the functionality of the two chambers may also contribute to cardiac dysfunction and clinical heart disease. Purpose This study aimed to study the coupling between the LV and LA in pediatric patients with isolated MVP having moderate mitral regurge by utilizing strain parameters and the left atrioventricular coupling index (LACI). Methods A retrospective analysis was conducted over two years to identify patients who had cardiac MRI with a diagnosis of MVP and moderate mitral regurgitation. Patients with bundle branch block, associated congenital heart diseases, rheumatic heart diseases, renal dysfunction, left ventricular systolic dysfunction were excluded. The study included 20 patients and 20 healthy controls. Functional and strain assessments of the LV, right ventricle (RV), and LA were performed and compared to those of healthy controls. LACI was determined by calculating the ratio of the indexed LA end-diastolic volume to the indexed left ventricular end-diastolic volume (LVEDVI). All procedures adhered to the guidelines set forth by the World Medical Association Declaration of Helsinki. Results LACI revealed a negative correlation with LVEDVI (r = -0.385, P=0.015) and total left atrial ejection fraction (LAEF) (r = -0.648, P 0.001). In addition, LACI showed a correlation with strain parameters, specifically with Longitudinal peak positive strain rate (LA SRs) (r = 0.350, P=0.037) and left ventricular global circumferential strain (LV GCS) (r = -0.488, P=0.003). The results from the multivariate regression analysis indicated that the left atrial longitudinal reservoir strain (ξs) was independently associated with left ventricular ejection fraction (LVEF) β=0.529; 95% confidence intervals (CI)= 0.192 to 0.866 and left ventricular global reservoir strain (LV GRS) β = 0.229; 95% CI = 0.128 to 0.330. There were statistically significant differences in LACI and LA ξs between patients who experienced clinical events such as arrhythmia and those who did not, with p-values of 0.014 and 0.016, respectively. Conclusions LACI was significantly higher in patients with symptomatic clinical events. However,Strain parameters were more insightful than LACI to demonstrate the LA-LV synchrony.CMR strain parameters Patient's exposure to clinical events
Shokeir et al. (Thu,) conducted a case-control in Isolated mitral valve prolapse with preserved ejection fraction and moderate mitral regurgitation (n=40). Isolated mitral valve prolapse with moderate mitral regurgitation vs. Healthy controls was evaluated on Association of left atrial longitudinal reservoir strain with left ventricular ejection fraction (β=0.529, 95% CI 0.192 to 0.866). In pediatric patients with isolated MVP, left atrial longitudinal reservoir strain was independently associated with LVEF (β=0.529; 95% CI 0.192-0.866), and LACI was higher in those with clinical events.