Key result
Increased LAVI linked to ~86% greater risk of adverse events in moderate or severe AS.
Why the study?
Enlarged left atrium may indicate longstanding diastolic dysfunction and advanced disease in aortic stenosis, but the impact of left atrial volume index on events needed assessment.
Does increased left atrial volume index predict adverse events in asymptomatic patients with moderate or severe aortic stenosis?
Observational (n=324)
Does increased left atrial volume index predict adverse events in asymptomatic patients with moderate or severe aortic stenosis?
In asymptomatic patients with moderate or severe aortic stenosis, an increased left atrial volume index (>34 ml/m2) is an independent predictor of adverse events, outperforming the E/e' ratio.
May aid risk stratification in asymptomatic moderate-severe AS; hypothesis-generating and should not yet change practice.
Objective In aortic stenosis (AS), chronic pressure overload on left ventricle (LV) leads to LV hypertrophy, impaired relaxation, increased chamber stiffness, fibrosis and left atrial (LA) dilatation. An enlarged LA may be a marker of longstanding diastolic dysfunction (DD) and more advanced disease in AS. We aimed to assess the impact of LA volume index (LAVI) on events in patients with moderate or severe AS. Methods A total of 324 patients (mean age 69 ± 13 years, 61% men) were included. LA volume was measured by biplane Simpson's method using apical four‐ and two‐chamber views and indexed to body surface area. An increased LAVI was defined as > 34 ml/m 2 . Results The mean EF was 64 ± 8%, LAVI 35 ± 14 ml/m 2 and flow rate 244 ± 70 ml/s. The number of total events was 275 (85%): 243 (75%) aortic valve replacement and 32 (10%) deaths. Mean follow‐up 23.7 ± 23.8 months (median 15.2 months). An increased LAVI (45% [ n = 145]) was associated with adverse events (HR 1.86; 95% CI 1.24–2.82, p = 0.003) independent of age, smoking, diabetes, atrial fibrillation, LV ejection fraction, LV mass, aortic valve area, and low flow rate (<200 ml/s). In the same multivariate model, when increased LAVI was replaced by E/e′ ratio ≥14 cm, no association was found between E/e’ ratio ≥14 cm and adverse events (HR 1.18; 95% CI .78–1.78, p = 0.430). Conclusion LAVI was an independent predictor of adverse events in patients with moderate or severe AS and preserved ejection fraction. Including LAVI in the risk assessment of AS patients may further improve risk stratification.
No takes yet. Share an insight, caveat, or question.
Saeed et al. (2021) conducted an observational in Asymptomatic moderate or severe aortic stenosis (n=324). Increased left atrial volume index (>34 ml/m2) vs. Normal left atrial volume index was evaluated on Adverse events (aortic valve replacement and deaths) (HR 1.86, 95% CI 1.24-2.82, p=0.003). Increased left atrial volume index (>34 ml/m2) independently predicted adverse events in patients with moderate or severe aortic stenosis (HR 1.86; 95% CI 1.24-2.82; p=0.003).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: