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Plasma levels of NT-proBNP were determined using the Elecsys proBNP? electrochemiluminescence immunoassay (Roche Diagnostics, Mannheim, Germany). Echocardiography. An echocardiographic evaluation was performed the day before MVS and six months postoperatively. An additional echocardiographic study was performed within 4-7 days postoperatively as routine practice outside the study protocol. All echocardiographic measurements within the study protocol were performed by two investigators who were blinded to the clinical data. The severity of MR, and the chamber size and function were quantified see more using color Doppler and 2D echocardiography, and evaluated according to Rapamycin previously validated criteria [13, 14]. The atrial volumes were determined using the bi-plane modified Simpson method, and indexed to the body surface area. The ejection fraction was measured using the bi-plane Simpson disk method. LARR was defined as a postoperative reduction in left atrial volume index (LAVi) ��15% [5, 6]. Patients were categorized as having severe preoperative LA enlargement when LAVi exceeded 60 mL/m2 [9]. Statistical analysis. Categorical variables were expressed as proportions and percentages and continuous variables as the mean �� 1 standard deviation. The paired-samples T-test was used for continuous variables, and categorical data were compared using the chi-squared test, or Fisher��s exact test when the expected frequency was less than five. For skewed distributed variables, the Mann-Whitney U test was used. Statistical significance was defined as p IRS1 6.1 months, interquartile range 6.0-7.2), and totaled 18.7 patient-years. One 84-year-old patient succumbed from pneumonia 3.5 months after surgery. One patient declined to participate in the study 5 months postoperatively, and two patients had incomplete echocardiographic data. Data obtained six months after surgery included NT-proBNP levels and an echocardiographic assessment including severity of residual MR, determination of LAVi with assessment of LARR. Results Patient characteristics. The clinical characteristics of the study population are given in Table 1. Table 1 Pre- and perioperative characteristics. The etiology of MR was degenerative in all cases, including prolapse of the posterior leaflet (77.5%, n=31), anterior leaflet (5%, n=2), or both leaflets (17.5%, n=7). Five patients with no history of angina or myocardial infarction underwent concomitant coronary artery by-pass grafting in addition to mitral valve repair.