Echocardiographic assessment of left atrial structure and function in severe aortic stenosis with preserved vs. reduced left ventricular ejection fraction

Figures

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  Figure 1. The patients flowchart. LA, left atrial; AVA, aortic valve area; MPG, mean pressure gradient; LVEF, left ventricular ejection fraction; LVOT, left ventricular outflow tract.

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  Figure 2. Two-dimensional echocardiographic views of the left atrium (four- and two-chamber views) and three functional phases in severe AS patients with LVEF < 50% (A) and those with LVEF ≥ 50% (B). AS, aortic stenosis; LVEF, left ventricular ejection fraction; LASr, left atrial reservoir strain; LASct, left atrial contractile strain; LAScd, left atrial conduit strain.

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  Figure 3. Comparison of LA structural parameters in severe AS patients stratified by LVEF (< 50% vs. ≥ 50%) and controls: (a) LAVmax (mL), (b) LAVpre (mL), (c) LAVmin (mL), (d) LAVI (mL/m²), (e) LASV (mL), and (f) LAVp (mL). Abbreviations: AS = Aortic stenosis; LVEF = Left ventricular ejection fraction; LA = Left atrial; LAVmax = Left atrial maximal volume; LAVpre = Left atrial pre-systolic volume; LAVmin = Left atrial minimal volume; LAVI = Left atrial volume index; LASV = Left atrial stroke volume; LAVp = LA passive emptying volume.

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  Figure 4. Comparison of LA functional parameters in severe AS patients stratified by LVEF (< 50% vs. ≥ 50%) and controls: (a) LATEF (%), (b) LAVpEF (%), (c) LAVaEF (%), (d) LAEI (%), (e) LACI (%), and (f) LASI. Abbreviations: LA = Left atrial; AS = Aortic stenosis; LVEF = Left ventricular ejection fraction; LATEF = Left atrial total emptying fraction; LAVaEF = Left atrial active emptying fraction; LAVpEF = Left atrial passive emptying fraction; LAEI = Left atrial expansion index; LASI = Left atrial stiffness index; LACI = Left atrioventricular coupling index.

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  Figure 5. Comparison of LA strain parameters in severe AS patients stratified by LVEF (< 50% vs. ≥ 50%) and controls, mean ± SD. LA, left atrial; AS, aortic stenosis; LVEF, left ventricular ejection fraction; LASr, left atrial reservoir strain; LASct, left atrial contractile strain; LAScd, left atrial conduit strain; PALS, peak atrial longitudinal strain.

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  Figure 6. RCS analyses revealed nonlinear associations between LVEF and LA echocardiographic parameters in patients with severe AS: (a) LAVmax (mL), (b) LAVpre (mL), (c) LAVmin (mL), (d) LAVI (mL/m²), (e) LACI (%), (f) LASI, (g) LATEF (%), (h) LAVaEF (%), (i) LAVpEF (%), (j) LAEI (%), (k) LASr (%), and (l) LASct (%). Abbreviations: RCS = Restricted cubic splines; LA = Left atrial; AS = Aortic stenosis; LVEF = Left ventricular ejection fraction; LAVmax = Left atrial maximal volume; LAVpre = Left atrial pre-systolic volume; LAVmin = Left atrial minimal volume; LAVI = Left atrial volume index; LATEF = Left atrial total emptying fraction; LAVaEF = Left atrial active emptying fraction; LAVpEF = Left atrial passive emptying fraction; LAEI = Left atrial expansion index; LASI = Left atrial stiffness index; LACI = Left atrioventricular coupling index; LASr = Left atrial reservoir strain; LASct =Left atrial contractile strain.

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  Figure 7. Correlation analysis of echocardiographic parameters in patients with severe AS. (a) Heat maps of parameter correlations in patients with an LVEF < 50%; (b) Heat maps of parameter correlations in patients with an LVEF ≥ 50%. Color shading for each cell uses a red-blue gradient for the magnitude and direction of the correlation coefficient (red: high/positive correlation, blue: low/negative correlation), and the value within the cell represents the bivariate correlation coefficient. * P < 0.05; ** P < 0.01; *** P < 0.001, abbreviations are defined in the List of Abbreviations.