Prognostic value of left atrial strain in significant aortic valve disease: a systematic review and meta-analysis

Background Previous studies on aortic valve disease have mainly focused on the left ventricle, but increasing evidence suggests that left atrial strain also has prognostic value in significant aortic valve disease. Objective To systematically evaluate the prognostic value of left atrial strain in significant aortic valve disease. Methods Multiple electronic databases were searched for studies evaluating significant aortic stenosis (AS) or aortic regurgitation (AR) using peak left atrial longitudinal strain (PALS) from the inception of each database to 1 February 2025. There were no language or regional restrictions. The primary endpoint was a composite outcome comprising all-cause mortality, hospitalization for heart failure, aortic valve replacement, pulmonary hypertension, and postoperative new-onset atrial fibrillation. Results A total of 25 studies were included, involving 7,195 patients, with 2,039 (28%) patients experiencing primary endpoint events. The PALS was lower in the positive group (EVENT+) compared to the negative group (EVENT−) (SMD = −1.03, 95% CI [−1.22, −0.84], p < 0.05). For each unit increase in PALS, the risk of the primary endpoint event decreased by 7% (HR = 0.93, 95% CI [0.91, 0.96], p < 0.001). PALS exhibited consistent incremental predictive value in both the AR and AS cohorts, although the strength of its effect and the underlying mechanisms varied between groups. Conclusion PALS is an independent predictor of adverse cardiovascular events in patients with significant aortic valve disease. PALS has certain value in the prognosis of significant aortic valve disease. Systematic Review Registration [ www.crd.york.ac.uk/prospero/ ], identifier [CRD 42024623883].