Left atrial stiffness is in correlation with left atrial reservoir strain in pediatric patients with mitral regurgitation

Article type: Research Article

Authors: Begic, Zijo^a | Djukic, Milan^{b; c} | Begic, Edin^{d; e; *} | Aziri, Buena^d | Gojak, Refet^f | Mladenovic, Zorica^g | Begic, Nedim^a | Badnjevic, Almir^h

Affiliations: [a] Deparment of Cardiology, Pediatric Clinic, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina | [b] Department of Cardiology, University Children’s Hospital, Belgrade, Serbia | [c] Faculty of Medicine, University of Belgrade, Belgrade, Serbia | [d] Department of Pharmacology, Sarajevo Medical School, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina | [e] Department of Cardiology, General Hospital “Prim. Dr. Abdulah Nakas”, Sarajevo, Bosnia and Herzegovina | [f] Clinic for Infectious Diseases, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina | [g] Department of Cardiology, Military Medical Academy, University of Defense, Belgrade, Serbia | [h] Verlab Research Institute for Biomedical Engineering, Medical Devices and Artificial Intelligence, Sarajevo, Bosnia and Herzegovina

Correspondence: [*] Corresponding author: Edin Begic, Department of Cardiology, General Hospital “Prim.dr Abdulah Nakas” Kranjceviceva 12, 71000 Sarajevo, Bosnia and Herzegovina. Tel.: +387 33 285 100; Fax: +387 33 285 370; E-mail: [email protected]. ORCID: 0000-0001-6842-262X.

Abstract: BACKGROUND: Left atrial stiffness index (LASI), defined as the ratio of early diastolic transmitral flow velocity/lateral mitral annulus myocardial velocity (E/e’) to peak atrial strain, reflects reduced left atrial (LA) compliance and represents an emerging marker that can be used for noninvasive measurement of fibrosis of LA in patients with mitral regurgitation (MR). OBJECTIVE: To investigate the impact of chronic MR in children and adolescents on the remodeling and function of the LA, quantified through strain parameters and diastolic function. METHODS: The study included fifty patients (n= 50) diagnosed with primary and secondary chronic MR lasting at least 5 years. The echocardiographic recordings were performed by a third party, two cardiologists actively engaged in echocardiography on a daily basis. RESULTS: Older participants had higher values of the LASI (r= 0.467, p= 0.001). Participants with higher LASI values had a smaller LA reservoir (r= 0.784, p= 0.0001) and smaller LA conduit values (r=-0.374, p= 0.00). Participants with higher LASI values had a larger LA diameter (r= 0.444, p-value= 0.001) and higher average E/e’ ratio (r= 0.718, p= 0.0001). There was a significant difference (p= 0.04) in the LASI among participants based on the MR jet area (< 20.85% ⩾ 20.85%), LASI was higher in participants with an area greater than 20.85%. Differences in other parameters such as LA reservoir, LA conduit, LA contractile were not statistically significant. CONCLUSION: Increased LA stiffness is associated with diminished atrial compliance and reservoir capacity, and LASI has a potential to as an early marker for assessing disease severity and progression in pediatric MR.

Keywords: Left atrium, mitral regurgitation, echocardiography, fibrosis

DOI: 10.3233/THC-240402

Journal: Technology and Health Care, vol. 32, no. 5, pp. 3525-3533, 2024