What does this research mean for the field?

Impaired left atrial conduit function, assessed via speckle tracking echocardiography, is a significant predictor of adverse cardiovascular events in patients with congenital aortic stenosis. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

April 6, 2022European Heart Journal OpenOpen Access

Prognostic value of left atrial strain in patients with congenital aortic stenosis

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Why the study?

It was unknown whether left atrial strain assessed by speckle tracking echocardiography could contribute to prognostication in patients with congenital aortic stenosis.

Does impaired left atrial conduit strain assessed by speckle tracking echocardiography predict adverse cardiovascular events in patients with congenital aortic stenosis?

Structured PICO

Does impaired left atrial conduit strain assessed by speckle tracking echocardiography predict adverse cardiovascular events in patients with congenital aortic stenosis?

Population

98 outpatients with stable congenital aortic stenosis (mean age 35.0 ± 11.9 years, 59.2% female, 99% NYHA class I) and 121 healthy controls (mean age 43.9 ± 13.8 years, 55.4% female).

Intervention

Assessment of left atrial conduit strain (LAS-cd) and strain rate (LASR-cd) using speckle tracking echocardiography.

Comparator

Preserved vs. depressed left atrial conduit strain and strain rate; comparison with healthy controls.

Outcome

Composite of any adverse cardiovascular event (all-cause mortality, heart failure requiring initiation or change in medication or hospital admission, hospitalizations due to cardiovascular disease, arrhythmias requiring treatment, thromboembolic events, or surgical or percutaneous interventions).composite

Impairment in left atrial conduit function assessed by speckle tracking echocardiography provides independent prognostic value for adverse cardiovascular events in patients with congenital aortic stenosis.

Limitations

Not designed to demonstrate the natural progression of LA functional adverse remodelling (lacks longitudinal echocardiographic follow-up)
Extrapolation to patients with degenerative aortic stenosis might not be appropriate due to differences in pathophysiology
Inherent intervendor variability with left atrial strain analysis software

Implication

May support LA strain for risk stratification in congenital AS; leaves open prospective validation before clinical use.

Abstract

Aim To explore whether left atrial (LA) strain with speckle tracking echocardiography (STE) can contribute to prognostication in patients with congenital aortic stenosis (CAS). Methods and results In this prospective study, consecutive outpatients with stable CAS and healthy adults were enrolled between 2011 and 2015. Left atrial function was analysed with STE using Tomtec software. Associations between LA strain (LAS) measurements and primary composite outcome (any adverse cardiovascular event, hospitalization, or re-intervention) and secondary outcome (re-interventions) were assessed with Cox regression analysis. In total, 98 patients with CAS (mean age: 35.0 ± 11.9 year, female: 59.2%) and 121 controls (age: 43.9 ± 13.8 year, female: 55.4%) were included. The majority of patients were in NYHA class I: 97 (99%) at baseline. At baseline, LA conduit strain (LAS-cd) and strain rate (LASR-cd) were significantly lower in patients than in controls when corrected for age and sex (−18.1 ± 8.7 vs. −23.5 ± 9.9%, P = 0.001 and −0.73 ± 0.31 vs. −1.02 ± 0.43/s, P < 0.001). During a median follow-up of 6.4 years (5.7–7.1), the primary composite outcome occurred in 48 (39.6%) patients. Kaplan–Meier analysis showed that decreased LAS-cd (<21%) was associated with a higher occurrence of the primary outcome (log-rank: P = 0.008). Depressed LAS-cd and LASR-cd were both associated with the primary composite outcome [univariable hazard ratio (HR) = 0.64(0.46–0.88), P = 0.005 and HR = 0.68(0.55–0.83), P < 0.001, respectively]; adjusted HR (for LAS-cd and LASR-cd, respectively): 0.31(0.09–1.04), P = 0.06 and 0.49(0.26–0.89), P = 0.02. Conclusion Impairment in LA conduit function assessed with STE carries prognostic value in patients with CAS and can be implemented in clinical management.