Left atrial remodeling in mitral regurgitation: A combined experimental-computational study

AimsProgressive changes to left atrial (LA) structure and function following mitral regurgitation (MR) remain incompletely understood. This study aimed to demonstrate potential underlying mechanisms using experimental canine models and computer simulations. MethodsA canine model of MR was created by cauterization of mitral chordae followed by radiofrequency ablation-induced left bundle-branch block (LBBB) after 4 weeks (MR-LBBB group). Animals with LBBB alone served as control. Echocardiography was performed at baseline, acutely after MR induction, and at 4 and 20 weeks, and correlated with histology and computer simulations. ResultsAcute MR augmented LA reservoir and contractile strain (40 +/- 4 to 53 +/- 6% and -11 +/- 5 to -22 +/- 9% respectively, p<0.05). LA fractional area change increased significantly (47 +/- 4 to 56 +/- 4%, p<0.05) while LA end-systolic area remained unchanged (7.2 +/- 1.1 versus 7.9 +/- 1.1 cm(2) respectively, p = 0.08). LA strain 'pseudonormalized' after 4 weeks and decompensated at 20 weeks with both strains decreasing to 25 +/- 6% and -3 +/- 2% respectively (p<0.05) together with a progressive increase in LA end-systolic area (7.2 +/- 1.1 to 14.0 +/- 6.3 cm(2), p<0.05). In the LBBB-group, LA remodeling was less pronounced. Histology showed a trend towards increased interstitial fibrosis in the LA of the MR-LBBB group. Computer simulations indicated that the progressive changes in LA structure and function are a combination of progressive eccentric remodeling and fibrosis. ConclusionMR augmented LA strain acutely to supranormal values without significant LA dilation. However, over time, LA strain gradually decreases (pseudornormal and decompensated) with LA dilation. Histology and computer simulations indicated a correlation to a varying degree of LA eccentric remodeling and fibrosis.

Automated summary

This study aimed to investigate the mechanisms underlying the progressive changes in left atrial structure and function following mitral regurgitation through experimental canine models and computer simulations. The results showed that acute mitral regurgitation increased left atrial strain without significant dilation, but over time, left atrial strain gradually decreased with dilation. Histology and computer simulations indicated a correlation with progressive eccentric remodeling and fibrosis of the left atrium.