Chronic mild to moderate mitral regurgitation will not have an impact on left atrial strain parameters in the pediatric population

Article type: Research Article

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

Affiliations: [a] Department 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] 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 strain (LAS) analysis represents a newer non-invasive, sensitive and specific technique for assessing left atrial (LA) function and early detection of its deformation and dysfunction. However, its applicability in mitral regurgitation (MR) in pediatric population remains unexplored, raising pertinent questions regarding its potential role in evaluating the severity and progression of the disease. OBJECTIVE: To investigate the impact of chronic MR in children and adolescents on LA remodeling and function. METHODS: The study included 100 participants. Patients with primary and secondary chronic MR lasting at least 5 years fit our inclusion criteria. The exclusion criteria from the study were: patients with functional mitral regurgitation due to primary cardiomyopathies, patients with artificial mitral valve, patients with MR who had previously undergone surgery due to obstructive lesions of the left heart (aortic stenosis, coarctation of the aorta), patients with significant atrial rhythm disorders (atrial fibrillation, atrial flutter). The echocardiographic recordings were conducted by two different cardiologists. Outcome data was reported as mean and standard deviation (SD) or median and interquartile range (Q1–Q3). RESULTS: The study included 100 participants, of whom 50 had MR and the remaining 50 were without MR. The average age of all participants was 15.8 ± 1.2 years, with a gender distribution of 37 males and 63 females. There was a significant difference in the values of LA volume index (LAVI), which were higher in patients with MR (p= 0.0001), S/D ratio (and parameters S and D; p= 0.001, p= 0.0001, p= 0.013), mitral annulus radius (p= 0.0001), E/A ratio (p= 0.0001), as well as septal e’ (m/s), lateral e’ (m/s), and average E/e’ ratio, along with the values of TV peak gradient and LV global longitudinal strain (%). There was no significant difference in LA strain parameters, nor in LA stiffness index (LASI). CONCLUSION: Our findings revealed significant differences in several echocardiographic parameters in pediatric patients with MR relative to those without MR, providing insight into the multifaceted cardiac structural and functional effects of MR in this vulnerable population.

Keywords: Left atrium, mitral regurgitation, echocardiography, fibrosis

DOI: 10.3233/THC-240768

Journal: Technology and Health Care, vol. Pre-press, no. Pre-press, pp. 1-8, 2024