Are left atrial distensibility and left atrial strain associated with left ventricular dysfunction and prognosis in patients with moderate to severe aortic stenosis?
Left atrial distensibility and left atrial strain are independently associated with adverse events in patients with moderate to severe aortic stenosis.
Objective To test the relationship between left atrial ( LA ) distensibility ( LAD ), LA strain ( LAS ), and left ventricular ( LV ) dysfunction and prognosis in aortic stenosis ( AS ). Methods Transthoracic Doppler echocardiography was performed prospectively in 102 consecutive patients with AS (77 with severe, 25 with moderate, mean age 77 years). LA volume was calculated by the area‐length method in apical four‐ and two‐chamber views, immediately before mitral valve opening (Vol max ) and at mitral valve closure (Vol min ). LAD was defined as (Vol max – Vol min ) × 100%/Vol min . LAS (mean of maximal strain from the 4–2 chamber views) was conducted using a dedicated software package. The endpoint was hospitalization for heart failure and death from any cause. Results Left atrial strain, LAD , and LA vol/m² were significantly correlated with LV diastolic parameters, and PASP (all, P < 0.05). However, LAD and LAS but not LA vol/m² were significantly correlated with Charlson score, LV global longitudinal strain, and to transaortic mean gradient (all, P < 0.05). At a median follow‐up of 25 months, 53 patients had an event. LAS , LAD , LA vol/m², and Charlson index were associated with events (all, P < 0.05). In multivariate analysis, LAD , LAS , and Charlson index (all, P < 0.01) remained independently associated with events. Using a ROC curve analysis, LAD ≤ 69% and LAS ≤ 17% were the best cutoffs associated with an event. Conclusion In patients with moderate to severe AS , LAD and LAS are associated with LV dysfunction, AS severity, and are independently linked to events.
Meimoun et al. (Wed,) studied this question.