Aug 2026· Echocardiography· Vol 43 9, pp.
e70608
· 0 citations· 27 references
Medicine
TL;DR
MAC and its severity were associated with impaired LA reservoir function and a higher non-invasive stiffness index, and the index did not discriminate MAC better than its simpler components, so these cross-sectional findings are hypothesis-generating.
Abstract
Purpose
Mitral annular calcification (MAC) is associated with atrial fibrillation and diastolic dysfunction, but its relationship with left atrial (LA) mechanics is poorly defined. The ratio of E/e' to LA reservoir strain (LASr) is a non-invasive surrogate of, not a direct measure of, LA stiffness. We assessed MAC and its severity against LASr and this LA stiffness index (LASI).
Methods
In this single-center cross-sectional study with prospective recruitment, 112 adults in sinus rhythm with ejection fraction ≥50% (58 with MAC, 54 age- and sex-similar controls) underwent two-dimensional speckle-tracking echocardiography. MAC was graded mild to severe; LASI was calculated as E/e' divided by LASr.
Results
LASr was lower (23.2 ± 7.8% vs. 26.7 ± 7.7%, p = 0.018) and LASI higher (0.57 ± 0.30 vs. 0.34 ± 0.20, p < 0.001) in the MAC group. In models excluding the index components, MAC severity was independently associated with higher LASI (β = 0.41, p < 0.001) and MAC presence with lower LASr (-3.6 points, p = 0.016). After clinical adjustment, each 0.1-unit LASI increase was associated with MAC (odds ratio 1.71, 95% CI[1.34-2.17]). LASI discriminated MAC with an area under the curve of 0.762 (0.674-0.851; cut-off 0.31, sensitivity 79%, specificity 63%), which did not differ from E/e' (p = 0.52) or LA volume index (p = 0.48).
Conclusion
MAC and its severity were associated with impaired LA reservoir function and a higher non-invasive stiffness index. The index did not discriminate MAC better than its simpler components, so these cross-sectional findings are hypothesis-generating.
In severe rheumatic mitral stenosis with sinus rhythm, left atrial appendage (LAA) dysfunction increases thromboembolic risk, yet clinical guidelines provide no recommendations, and its assessment via transesophageal echocardiography is not feasible for routine or repeated use. This study assessed whether left atrial (LA) strain imaging could noninvasively predict LAA contractile dysfunction.
We prospectively enrolled 138 patients with severe rheumatic MS in sinus rhythm who underwent transthoracic and transesophageal echocardiography. LAA inactivity was defined as LAA emptying velocity <25 cm/s. LA reservoir (LASr), conduit, and contractile strain were quantified using speckle-tracking echocardiography. Multivariable logistic regression and receiver-operating characteristic (ROC) analyses were performed to evaluate predictors of LAA inactivity. LAA inactivity was observed in 108 patients (78.2%), and LAA thrombus was detected in 8 patients (5.8%)—all in sinus rhythm. In multivariate analysis, LASr was the strongest independent predictor of LAA inactivity (OR 0.61 per 1% increase; 95% CI: 0.50–0.75; p < 0.0001). LASr yielded an AUC of 0.950 (95% CI: 0.911-0.989), with a threshold of ≤22.95% showing a sensitivity of 93.5%, and specificity of 90% for predicting LAA inactivity. Impaired LA strain identified patients with elevated fibrinogen, D-dimer, and the presence of LAA thrombus.
LA strain imaging provides a robust noninvasive predictor of LAA dysfunction in severe rheumatic MS patients in sinus rhythm. These findings support the potential clinical utility of LA strain in improving risk stratification and guiding anticoagulation decisions in this under-recognized high-risk population.
J. Yusuf, Gaurav Sharma, Ankit Bansal et al.· European Heart Journal Open· 0 citations
In individuals free of overt cardiovascular disease, MRI-derived LV filling dynamics were associated with structural alterations of the left atrium and pulmonary vasculature, suggesting that changes across the cardiopulmonary axis may already be detectable by whole-body MRI before clinical disease becomes apparent.
C. Wintergerst, R. Lorbeer, Susanne Rospleszcz et al.· Frontiers in Cardiovascular...· 0 citations
Mitral annular calcification (MAC) is recognized as a marker of cardiovascular risk. However, the structural and hemodynamic predictors of its presence and severity remain insufficiently defined. We analyzed a large, consecutive cohort of 49,093 individuals undergoing echocardiography at our tertiary medical center, classifying them into three groups: normal annulus (79.5%), MAC (17.3%), or severe MAC (3.2%). Clinical and echocardiographic multivariable logistic regression models were used to identify independent predictors of MAC presence and severity. Age was a significant predictor of MAC and was characterized by a marked age-by-sex interaction, with the prevalence diverging after age 60. Severe MAC was twice as frequent in women aged ≥70 years. Diabetes, hypertension, renal dysfunction, obesity and heart failure with preserved ejection fraction (HFPEF) were significant independent predictors of MAC. After incorporation of structural variables, concentric remodeling and diastolic parameters emerged as significant determinants. Increased absolute and relative wall thickness, smaller left ventricular end diastolic dimension (LVEDD), higher E/e', left atrial enlargement, and elevated pulmonary pressures were significant predictors of the presence of MAC. Among individuals with MAC, severity was associated with age, sex, diabetes, HFPEF, smaller LVEDD, and elevated filling pressures. During 1,786 days of median follow-up, MAC was an independent predictor of mortality (severe MAC: HR 1.29, 95% CI 1.12-1.48, p<0.001). In conclusion, MAC is age and sex-related and is significantly associated with structural features of a diastolic impairment profile. Severe MAC serves as an indicator of cardiac remodeling and may warrant focused management of diastolic dysfunction and systemic metabolic risk.
Israel Gotsman, Ruth Shnipper, D. Zwas et al.· American Journal of Cardiolo...· 0 citations
A
BSTRACT
Chronic left atrial (LA) pressure overload and rheumatic inflammation cause subclinical atrial remodeling even without severe valvular stenosis. This study intended to determine whether advanced atrial deformation parameters identify patients with increased risk of atrial fibrillation (AF) from mild rheumatic mitral stenosis (MS).
A prospective cohort study of patients with mild rheumatic MS and sinus rhythm was conducted in Baghdad, Iraq. LA Reservoir Strain (LASr) and LA Mechanical Dispersion (LAMD) were calculated via two-dimensional strain echocardiography at baseline. Patients were followed up for at least 2 years. The primary outcome was the occurrence of AF.
Of 211 patients, 39 were found to have new-onset AF. The two strain parameters remained independent predictors of new-onset AF on multivariable Cox proportional hazards regression analysis. New AF occurrence was positively correlated with LAMD (adjusted Hazard ratio [aHR]: 1.047 [95% confidence interval (CI): 1.02–1.06],
P
< 0.001) and inversely correlated with LASr (aHR: 0.848 [95% CI: 0.79–0.90],
P
< 0.001). The optimal thresholds for LAMD and LASr for predicting new AF were >58.7 ms and ≤16.6%, respectively, which were defined by the Receiver Operating Characteristic curve.
The presence of subclinical electromechanical dysfunction is an independent predictor of AF in mild rheumatic MS. Recognizing this high-risk phenotype supports closer ambulatory rhythm monitoring to allow timely arrhythmia detection and subsequent initiation of anticoagulation to prevent thromboembolic events.
Left and right atrial stiffness are both associated with adverse outcome in DCM and add prognostic information to an LV-centred risk model, and their unweighted sum offers a single parsimonious measure.
A. Vijiiac, I. Petre, S. Onciul et al.· Journal of Clinical Medicine· 0 citations
In patients with DMR, AF was associated with more advanced LA structural remodeling, impaired LA function, and higher CMR LGE burden, and echocardiographic LA functional parameters may provide complementary information for the discrimination of AF.
X. Li, Y. Song, Y. Hu et al.· medRxiv· 0 citations
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