What does this research mean for the field?

Left atrial volume >95 mL and LAV/BSA >50 mL/m² are associated with a higher risk of death in patients with aortic stenosis (HR 1.40 and 1.42, respectively). Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

What question did this study set out to answer?

This study aims to evaluate how left atrial volume (LAV) predicts mortality in patients with aortic stenosis (AS).

November 1, 2017Journal of the American Heart AssociationOpen Access

Left Atrial Volume and Mortality in Patients With Aortic Stenosis

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Key result

Left atrial volume >95 mL linked to ~40% higher mortality risk in aortic stenosis.

HR 1.40

Why the study?

Does left atrial enlargement (LAV >95 mL or LAV/BSA >50 mL/m2) predict increased all-cause mortality in patients with aortic stenosis?

Key Points

This study aims to evaluate how left atrial volume (LAV) predicts mortality in patients with aortic stenosis (AS).
Included 1351 patients with aortic stenosis in sinus rhythm.
Analyzed all-cause death during follow-up with both medical and surgical management.
Tested five parameters of left atrial enlargement, including nonindexed and normalized left atrial volume.
Patients with LAV >95 mL had an adjusted hazard ratio of 1.40 (95% CI, 1.06–1.88) for mortality.
LAV normalized to body surface area >50 mL/m² had an adjusted hazard ratio of 1.42 (95% CI, 1.08–1.91).
LA enlargement significantly associated with mortality in patients with severe AS, preserved ejection fraction, and minimal symptoms (HR 1.87 for LAV >95 mL).

Structured PICO

Does left atrial enlargement (LAV >95 mL or LAV/BSA >50 mL/m2) predict increased all-cause mortality in patients with aortic stenosis?

Population

1,351 patients ≥18 years of age with ≥mild aortic stenosis (AS) in sinus rhythm at diagnosis. Mean age 73.5, 55.4% male. Key exclusions: >mild aortic and/or mitral regurgitation, prosthetic valves, congenital heart disease, supravalvular or subvalvular AS, dynamic LV outflow tract obstruction, mitral stenosis, and atrial fibrillation on baseline ECG.

Intervention

Left atrial enlargement, specifically defined as left atrial volume (LAV) >95 mL or LAV normalized to body surface area (LAV/BSA) >50 mL/m2

Comparator

No or mild left atrial enlargement (LAV ≤95 mL or LAV/BSA ≤50 mL/m2, or lower quartiles)

Outcome

All-cause death during follow-up with medical and surgical managementhard clinical

Left atrial enlargement (LAV >95 mL or LAV/BSA >50 mL/m2) is an independent predictor of all-cause mortality in patients with aortic stenosis, providing a sensitive marker of risk even in asymptomatic patients with preserved ejection fraction.

Limitations

Larger prospective studies are needed to validate the prognostic value of LAV in asymptomatic severe AS

Discussion

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Implication

May aid risk stratification in aortic stenosis; extends prior data but leaves open impact on management decisions.

Cite This Study

Ruşinaru et al. (2017) studied this question. Left atrial volume >95 mL and LAV/BSA >50 mL/m² are associated with a higher risk of death in patients with aortic stenosis (HR 1.40 and 1.42, respectively).

synapsesocial.com/papers/696f02702c0018714d31bece https://doi.org/10.1161/jaha.117.006615

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