Left atrial dynamics and the pulmonary circulatory-right ventricular uncoupling in patients with severe degenerative mitral regurgitation

Abstract Funding Acknowledgements Type of funding sources: None. Background The uncoupling right ventricular (RV) function to pulmonary circulation (Pc) represents a prognostic index in patients affected by degenerative mitral regurgitation (DMR) undergoing surgical or percutaneous repair. In this context, the deterioration Left Atrial (LA) dynamics favors development venous congestion and vascular remodeling, triggering hypertension (PH) dysfunction. However, relationship between LA RV-to-Pc coupling is not well defined population. Purpose aim study was investigate association uncoupling, assessed ratio tricuspid annular plane systolic excursion (TAPSE) artery pressure (PAPS), dynamics, evaluated with Speckle Tracking Echocardiography (STE), DMR. Methods 351 consecutive hemodynamically-significant DMR who were for cardiac surgery at San Raffaele Hospital underwent complete transthoracic transesophageal echocardiography retrospectively enrolled (mean age 59±14 years, 65% males). Patients then stratified two groups according TAPSE/PAPS (group I: >0.4 mm/mmHg; group II: ≤0.4 mm/mmHg). analyzing strain peak relaxation (Global atrial longitudinal strain) STE analysis performed offline. All sinus rhythm. Results At baseline, exhibited normal LV dimensions (EDVi 70±20 ml/m2, LVEF 63±6%), increased size (48±20 ml/m2) mean GPALS 26±13%. Additionally, preserved RV PC found population (average TAPSE/PASP admission: 0.84±0.2 mm/mmHg), only 10% cohort exhibiting reduced ratio. When RV-to-PC coupling, higher (>0.4 mm/mmHg) significantly values reservoir 27.8±12.7% vs II 22.7±11.3%; p = 0.04) (Figure 1, 2). direct correlation LA-Strain noticed (r=0.3, CI 95% 0.21–0.5; p<0.001). Conclusions DMR, there strong echo-derived measures mechanics Pc correlating better functioning coupling. These results, although preliminary, suggest importance multiparametric approach risk-stratification these patients, potentially improving long-term outcome.