JACC: Basic to Translational Science (Feb 2020)
Reduced Left Atrial Emptying Fraction and Chymase Activation in Pathophysiology of Primary Mitral Regurgitation
- Brittany Butts, PhD,
- Mustafa I. Ahmed, MD,
- Navkaranbir S. Bajaj, MD, MPH,
- Pamela Cox Powell, MS,
- Betty Pat, PhD,
- Silvio Litovsky, MD,
- Himanshu Gupta, MD,
- Steven G. Lloyd, MD,
- Thomas S. Denney, PhD,
- Xiaoxia Zhang, PhD,
- Inmaculada Aban, PhD,
- Sakthivel Sadayappan, PhD, MBA,
- James W. McNamara, PhD,
- Michael J. Watson, PhD,
- Carlos M. Ferrario, MD,
- James F. Collawn, PhD,
- Clifton Lewis, MD,
- James E. Davies, MD,
- Louis J. Dell’Italia, MD
Affiliations
- Brittany Butts, PhD
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
- Mustafa I. Ahmed, MD
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
- Navkaranbir S. Bajaj, MD, MPH
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
- Pamela Cox Powell, MS
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
- Betty Pat, PhD
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
- Silvio Litovsky, MD
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
- Himanshu Gupta, MD
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama; Department of Veterans Affairs Medical Center, Birmingham, Alabama; Department of Cardiology, Valley Health System, Paramus, New Jersey
- Steven G. Lloyd, MD
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama; Department of Veterans Affairs Medical Center, Birmingham, Alabama
- Thomas S. Denney, PhD
- Department of Electrical and Computer Engineering, Auburn University School of Engineering, Auburn, Alabama
- Xiaoxia Zhang, PhD
- Department of Electrical and Computer Engineering, Auburn University School of Engineering, Auburn, Alabama
- Inmaculada Aban, PhD
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
- Sakthivel Sadayappan, PhD, MBA
- Division of Cardiovascular Disease, University of Cincinnati College of Medicine, Cincinnati, Ohio
- James W. McNamara, PhD
- Division of Cardiovascular Disease, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Michael J. Watson, PhD
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University, Durham, North Carolina
- Carlos M. Ferrario, MD
- Department of Surgery, Wake Forest University Health Science Center, Winston-Salem, North Carolina
- James F. Collawn, PhD
- Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Birmingham, Alabama
- Clifton Lewis, MD
- Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of Alabama at Birmingham, Birmingham, Alabama
- James E. Davies, MD
- Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of Alabama at Birmingham, Birmingham, Alabama
- Louis J. Dell’Italia, MD
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama; Department of Veterans Affairs Medical Center, Birmingham, Alabama; Address for correspondence: Dr. Louis J. Dell’Italia, Birmingham VA Medical Center, 700 South 19th Street, Birmingham, Alabama 35233.
- Journal volume & issue
-
Vol. 5,
no. 2
pp. 109 – 122
Abstract
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. Key Words: chymase, fibrosis, left atrium, left ventricle, mitral regurgitation, mitral valve
