The Differences of Echocardiographic Features between Mitral Regurgitation Patients with Sinus Rhythm and Atrial Fibrillation

Author : V. B Kusmanto, A. M. Soesanto, E. Rudiktyo, R. Ariani, B. R. M. A. S. Kuncoro
Upload Date : 19-04-2018

Background: Mitral regurgitation (MR) could lead to left atrial (LA) enlargement. LA enlargement contributes to atrial fibrillation (AF) development. This study aim to analyze characteristic differences between MR patients with sinus rhythm and AF based on its etiology.

Method: This is a cross sectional study analyzing the National Cardiovascular Center Harapan Kita valvular registry database for moderate to severe MR patients with degenerative and rheumatic etiology who had transthoracic echocardiographic examination from July 2016 to June 2017. Each etiology was further categorized into two groups based on the ECG rhythm: sinus and AF. Other ECG rhythms were excluded. Demographic characteristics and echocardiographic parameters were compared.

Results: 296 patients were included: 239 degenerative and 57 rheumatic MR patients. In both groups, patients with AF had lower TAPSE [(degenerative MR: sinus= 2,4 ±0,5cm vs AF= 1,9 ±0,4cm; p = 0.000); (rheumatic MR: sinus= 2,5 ±0,4cm vs AF= 1,8 ±0,5cm; p = 0.000)].  LAVI in AF patients was also greater in both groups [(degenerative MR: sinus= 64,1ml/m2±36,1 vs AF= 126,6 ±103,8ml/m2; p = 0.000); (rheumatic MR: sinus= 98,4 ±49,3ml/m2 vs AF= 173,6 ±119,4ml/m2; p = 0.010)]. Within degenerative MR group, only patients with AF had lower PV AccT (PVAccT: sinus= 118,1 ±33,9msec vs AF= 95,9 ±22,0msec; p = 0.000). Interestingly, this phenomenon was not seen in rheumatic MR patients (PVAccT: sinus= 103,9 ±23,2msec vs AF= 95,4 ±22,5msec; p = 0.229). Degenerative MR patients with AF were older (sinus= 48,9 ±12,8 years old vs AF= 56,2 ±11,1 years old; p = 0.000).

Conclusions: In both rheumatic and degenerative MR, patients with AF had lower right ventricular function and greater LA volume compared to patients with sinus rhythm. Degenerative MR patients with AF had significantly lower PV Acct, while there was no difference seen in rheumatic MR.

KEYWORDS : mitral regurgitation, atrial fibrillation, echocardiography

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