Prognostic Implications of Left Atrial Enlargement in Degenerative Mitral Regurgitation

International audienceBACKGROUND Left atrial enlargement is frequent in degenerative mitral regurgitation (DMR), but its link to outcomes remains unproven in routine clinical practice. OBJECTIVES The purpose of this study was to assess whether left atrial volume index (LAVI) measured in routine clinical practice of multiple sonographers/cardiologists is associated independently with DMR survival. METHODS A cohort of 5,769 (63 +/- 16 years, 47% women) consecutive patients with degenerative mitral valve disease, in whom LAVI was prospectively measured, was enrolled and the long-term survival was analyzed. RESULTS LAVI (43 +/- 24 ml/m(2)) was widely distributed (= 60 ml/m(2) in 1,009). Overall survival throughout follow-up (10-year 66 +/- 1%) was strongly associated with LAVI (79 coproduct 1% vs. 65 +/- 2% and 54 +/- 2% for LAVI = 60 ml/m(2), respectively; p = 60 ml/m(2) vs. = 60 ml/m(2), respectively; p < 0.0001). CONCLUSIONS The frequent left atrial enlargement of DMR as measured by LAVI in routine practice displays, overall and in all subsets, a powerful, incremental, and independent link to excess mortality, which is partially alleviated by mitral surgery. Hence, LAVI measurement should be part of routine DMR evaluation and the clinical decision-making process. (C) 2019 by the American College of Cardiology Foundation