Atrial coupling-index by standard echocardiography in degenerative mitral regurgitation: An incremental determinant of survival

Background We ought to determine the prognostic role of left atrial coupling-index (LACI), as left atrial volume-index (LAVI) by tissue-Doppler-Imaging a′ (TDI-a′), in a large cohort of degenerative mitral regurgitation (DMR). Methods All consecutive 4792 patients (61 ± 16 years, 48% women) with isolated DMR diagnosed at the Mayo Clinic 2003–2011, comprehensively characterized, in whom LAVI and TDI-a’ in sinus rhythm was prospectively measured in routine practice, was enrolled and their long-term survival analyzed. Results LACI (5.8 ± 3.7 – T1   6.3) was significantly higher through different DMR grades (no, mild, moderate, severe DMR: 3.77 ± 2.26, 5.08 ± 2.95, 6.54 ± 3.74 and 7.84 ± 4.29, respectively; P   6 was independently associated with worse clinical presentation. Total follow-up was 7.03 ± 3.0 years, during which 1146 (24%) underwent mitral valve surgery (94% repair – 6% replacement) and 880 (18%) died. Overall survival throughout follow-up (10-year 76 ± 1%) was strongly associated with LACI (88 ± 1% vs. 78 ± 1% and 62 ± 2% for LACI   5.79, P = 0.01). Survival improved after mitral-surgery (time-dependent adjusted-hazard-ratio 0.40[0.28–0.65], P  Conclusion LA function assessed by LACI in routine practice displays incremental and independent link to excess-mortality, partially alleviated by mitral-surgery. Thus, LACI is a simple tool of crucial interest in DMR risk stratification.