Early Reverse Remodeling of Left Atrial Volume Index Following Percutaneous Transvenous Mitral Commissurotomy: A Prospective Observational Study

Abstract

Objectives: Left atrial volume index (LAVI) is a well-established echocardiographic marker and an independent predictor of adverse cardiovascular outcomes. Aim of this study was to evaluate the change in LAVI from baseline to 30 days following successful percutaneous transvenous mitral commissurotomy (PTMC) in patients with severe mitral stenosis. Methodology: This prospective observational study was conducted at the National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan. Adult patients (≥18 years) with severe MS undergoing successful PTMC were included, while those with severe post-procedural mitral regurgitation were excluded. Patients were followed up at 30 days with repeat echocardiographic assessment. Analysis was restricted to patients with complete paired baseline and follow-up data. Results: Of 102 patients enrolled after successful PTMC, 88 completed the 30-day follow-up and were included in the final analysis. The cohort was predominantly female (72.7%) with a mean age of 34.3 ± 12.1 years. Median LAVI decreased significantly from 62 [52.5–75.5] mL/m² at baseline to 50 [43.5–66] mL/m² at 30 days (p<0.001), corresponding to a median absolute reduction of 11.6 [5.2–17.5] mL/m². The proportion of patients with LAVI ≤40 mL/m² increased from 4.5% to 18.2% (p<0.001). Pulmonary artery systolic pressure also showed a significant reduction (p<0.001). Conclusion: LAVI demonstrates significant early reduction within 30 days following successful PTMC, indicating the onset of reverse atrial remodeling. However, most patients continue to exhibit residual left atrial enlargement, suggesting that structural normalization may require longer follow-up. Further studies are needed to determine the prognostic implications of early LAVI changes.