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Original research
Prognostic impact of left ventricular global longitudinal strain in atrial mitral regurgitation
  1. Maria Chiara Meucci1,2,
  2. Jan Stassen1,3,
  3. Anton Tomsic4,
  4. Meindert Palmen4,
  5. Filippo Crea2,5,
  6. Jeroen J Bax1,6,
  7. Nina Ajmone Marsan1,
  8. Victoria Delgado1,7
  1. 1 Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
  2. 2 Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
  3. 3 Department of Cardiology, Jessa Hospital, Hasselt, Belgium
  4. 4 Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
  5. 5 Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
  6. 6 Heart Center, University of Turku and Turku University Hospital, Turku, Finland
  7. 7 Hospital University Germans Trias i Pujol, Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
  1. Correspondence to Dr Victoria Delgado, Leiden University Medical Center, Leiden, Netherlands; videlga{at}


Objective Left atrial (LA) and left ventricular (LV) mechanics are impaired in patients with atrial functional mitral regurgitation (AFMR), but their prognostic value in this subset of patients remains unknown. The present study aimed to evaluate the association between LA and LV longitudinal strain and clinical outcomes in patients with AFMR.

Methods A total of 197 patients (mean age 73±10 years, 44% men) with at least moderate AFMR were retrospectively identified. LV global longitudinal strain (GLS) and left atrial reservoir strain (LAS) were calculated by two-dimensional speckle tracking echocardiography. All-cause mortality was the primary endpoint of the study. The threshold value of LV GLS (≤16.3%) to identify impaired LV mechanics was defined based on the risk excess of the primary endpoint described with a spline curve analysis.

Results Impaired LV GLS (≤16.3%) was found in 89 (45%) patients. During a median follow-up of 69 months, 45 (23%) subjects experienced the primary endpoint. Patients with impaired LV GLS (≤16.3%) had a significantly lower cumulative survival rate at 5 years, as compared with patients with LV GLS (>16.3%) (74% vs 93%, p<0.001). On multivariable Cox regression analysis, LV GLS expressed as continuous variable was independently associated with the occurrence of all-cause mortality (HR 0.856, 95% CI 0.763 to 0.960; p=0.008) after adjustment for age, LAS, pulmonary artery systolic pressure and severe tricuspid regurgitation. Conversely, LAS was not significantly associated with patients’ outcome.

Conclusions In patients with significant AFMR, the impairment of LV GLS was independently associated with worse outcomes.

  • atrial fibrillation
  • echocardiography
  • mitral valve insufficiency

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors Concept and design: VD, NAM, JJB and MP. Acquisition, analysis and interpretation of the data: MCM, JS and AT. Drafting of the manuscript: MCM and VD. Critical revision of the manuscript: all the authors. Guarantor: VD.

  • Funding JS received funding from the European Society of Cardiology (ESC Training Grant App000080404).

  • Competing interests the Department of Cardiology, Heart Lung Center, Leiden University Medical Center, received research grants from Abbott Vascular, Bayer, Bioventrix, Medtronic, Biotronik, Boston Scientific, GE Healthcare and Edwards Lifesciences. JJB received speaking fees from Abbott Vascular. NAM received speaking fees from Abbott Vascular and GE Healthcare and has been in the Medical Advisory Board of Philips Ultrasound. VD received speaker fees from Abbott Vascular, Medtronic, Edwards Lifesciences, MSD and GE Healthcare. The remaining authors have nothing to disclose.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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