Reduced Left Atrial Emptying Fraction and Chymase Activation in Pathophysiology of Primary Mitral Regurgitation

Autor: Inmaculada Aban, Thomas S. Denney, Navkaranbir S. Bajaj, Mustafa I. Ahmed, Michael J. Watson, Carlos M. Ferrario, Xiaoxia Zhang, James E. Davies, Himanshu Gupta, James W. McNamara, Betty Pat, Clifton T. Lewis, Louis J. Dell’Italia, James F. Collawn, Silvio H. Litovsky, Sakthivel Sadayappan, Brittany Butts, Steven G. Lloyd, Pamela C. Powell
Jazyk: angličtina
Rok vydání: 2020
Předmět:
0301 basic medicine
mitral valve
medicine.medical_specialty
lcsh:Diseases of the circulatory (Cardiovascular) system
left ventricle
CLINICAL RESEARCH
030204 cardiovascular system & hematology
MV
mitral valve
MR
mitral regurgitation
left atrium
03 medical and health sciences
0302 clinical medicine
Fibrosis
Mitral valve
Internal medicine
Medicine
Myocyte
EF
ejection fraction
LA
left atrial
cardiovascular diseases
TEM
transmission electron microscopy
TGF
transforming growth factor
chymase
LA EF
left atrial emptying fraction
Mitral regurgitation
Ejection fraction
business.industry
fibrosis
Chymase
medicine.disease
Pathophysiology
RA
right atrial
030104 developmental biology
medicine.anatomical_structure
LV
left ventricle
lcsh:RC666-701
Cardiology
cardiovascular system
mitral regurgitation
Cardiology and Cardiovascular Medicine
business
Myofibril
Zdroj: JACC: Basic to Translational Science
JACC: Basic to Translational Science, Vol 5, Iss 2, Pp 109-122 (2020)
ISSN: 2452-302X
Popis: Visual Abstract
Highlights • Extensive LA fibrosis is related to an increase in LA size and decrease in total LA EF. This supports the contention that the LA is not merely a bystander of MR but rather is actively involved in the pathophysiology of MR. • Chymase is plentiful in the human heart, especially in the LA, and correlates with extracellular matrix accumulation in primary MR. • Because of the unreliability of the LV ejection fraction in primary MR, future studies may consider LA size and total LA EF for timing of surgical intervention of asymptomatic moderate to severe MR.
Summary Increasing left atrial (LA) size predicts outcomes in patients with isolated mitral regurgitation (MR). Chymase is plentiful in the human heart and affects extracellular matrix remodeling. Chymase activation correlates to LA fibrosis, LA enlargement, and a decreased total LA emptying fraction in addition to having a potential intracellular role in mediating myofibrillar breakdown in LA myocytes. Because of the unreliability of the left ventricular ejection fraction in predicting outcomes in MR, LA size and the total LA emptying fraction may be more suitable indicators for timing of surgical intervention.
Databáze: OpenAIRE
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