Predictors of heart failure hospitalization after surgery in patients with primary mitral regurgitation: the relevance of left atrial coupling index

Abstract Background and Aims The main indications for surgery in patients with primary mitral regurgitation (PMR) include the presence of symptoms, left ventricular dysfunction (LVEF ≤60%) and dilation (LVESD ≥ 40 mm), but novel markers are needed to detect early myocardial damage. Our aim was to explore the impact of echocardiographic parameters on the incidence of heart failure (HF) hospitalizations after surgery in our cohort of patients with PMR. Methods Retrospective analysis of a prospective cohort of patients with PMR who underwent mitral valve surgery in a tertiary care center from 2014 to 2022. Echocardiographic parameters measured prior to surgery were analyzed. The primary outcome was HF admissions during follow-up. Results 349 patients were included. The mean age was 69 (12) years and 55.9% were male. During a mean follow up of 3.28 (2) years, 13 patients (3.7%) were admitted due to HF. Variables significantly associated with HF admissions were: female gender, atrial fibrillation prior to surgery, LVEF, LV end-diastolic volume index, LV global longitudinal strain, left atrial coupling index [LACI] (end-diastolic left atrial volume/end-diastolic LV volume), TAPSE and right ventricular-arterial coupling. In a multivariable logistic regression analysis, the only independent predictors of HF admissions were female gender (OR 5.68), LVEF (OR 0.93) and LACI (1.87) (p<0.05). Conclusions In our cohort of patients with PMR, apart from LVEF, LACI was the only echocardiographic parameter independently associated with HF hospitalizations after surgery. This easy to obtain echocardiographic parameter, which takes into account the interrelation between LA and LV compliance, could help guide patients’ management in this setting.Table 1