Left Atrium Volume Index Measurement In Routine Practice: Does It Independently Impact Survival Of Degenerative Mitral Valve Disease?
Clemence Antoine1, Giovanni Benfari1, Sorin V. Pislaru1, David Messika-Zeitoun2, Thierry Le Tourneau3, Joseph F. Maalouf1, Maurice Enriquez-Sarano1.
1Mayo Clinic, rochester, MN, USA, 2Bichat Claude Bernard Hospital-Paris VII University, Paris, France, 3The Division of Cardiovascular Diseases Universite de Nantes, Nantes, France.
Background: Pilot studies suggest that an increased left atrial volume index (LAVI) negatively impacts survival of mitral regurgitation in sinus rhythm. However, the magnitude of the impact is uncertain as definitive data are lacking in routine practice. Furthermore, European and US guidelines are discordant on use of LAVI for degenerative mitral valve disease (DMVD) management. We studied LAVI impact on survival among DMVD, with and without AF. Methods and Results: During 2003-2011, 5769 patients were diagnosed at Mayo Clinic with isolated DMVD, all degrees of mitral regurgitation and measured LAVI. Age was 63±16 years, 47% were women. LAVI was <40mL/m² in 55% of patients, 40-59mL/m² in 28% and ≥60 ml/m² in 17% (overall mean LAVI 43±23 mL/m²). Larger LAVI at diagnosis was associated with excess mortality under medical treatment (hazard ratio: 1.22 [1.20-1.24] per 10 ml/m², p<0.0001) in univariate analysis. Association with excess mortality persisted after adjustment for mitral regurgitation severity, AF, symptoms, age and gender (hazard ratio: 1.05 [1.02-1.08] per 10 ml/m², p<0.0001) as in all subgroups, particularly AF and sinus rhythm (Figure). After mitral surgery, the association between LAVI and mortality was no longer present. Conclusion: In this large cohort of DMVD, LAVI measured in routine practice provides a strong independent prognostic value on mortality under medical treatment, regardless of AF presence. Thus LAVI is an essential component of the clinical decision-making process in DMVD.
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