Preprocedural Left Atrial Strain as a Predictor of Long-Term Outcomes Following Mitral Valve Interventions in Rheumatic Severe Mitral Stenosis

Abstract

Background: This study explores whether preprocedural left atrial (LA) strain predicts outcomes in individuals with rheumatic, severe mitral stenosis undergoing mitral valve (MV) interventions. Methods: Data were from the MASTER (Multicenter Mitral Stenosis with Rheumatic Etiology) registry, including patients with severe mitral stenosis who underwent percutaneous mitral valvuloplasty or MV replacement. Participants with moderate or greater dysfunction of other valves or missing strain data were excluded. The primary outcome was a composite of all-cause mortality and heart failure hospitalization. Decreased LA reservoir strain was defined as <12.2%, determined through receiver operating characteristic analysis. Results: Among 609 individuals (mean age 57.4 +/- 12.1 years; 73% women), 424 (69.6%) had MV replacement and 185 (30.4%) underwent percutaneous MV. Those with decreased LA strain (n=307) were older, had more atrial fibrillation, smaller MV area, elevated mean diastolic pressure gradient, and increased right ventricular systolic pressure than those with preserved LA strain (n=302). Over a median follow-up of 6.1 (2.3-10.7) years after MV intervention, 7.7% (n=47) experienced the primary outcome, with significantly higher rates observed in individuals with decreased LA strain (P=0.001). Multivariate analysis showed decreased LA strain (hazard ratio [HR], 2.04 [95% CI, 1.06-3.93]; P=0.001), older age, and higher right ventricular systolic pressure were independent predictors of adverse outcomes. Conclusions: Preprocedural decreased LA reservoir strain was associated with adverse clinical outcomes after MV intervention in individuals with severe mitral stenosis. These findings suggest that LA strain could serve as a marker for optimizing the timing of MV intervention.