Key result
Left atrial diameter predicted all-cause mortality independent of AS severity and Doppler parameters of diastolic function in asymptomatic patients with severe aortic stenosis.
Why the study?
Does left atrial size predict mortality and symptom development in asymptomatic patients with severe aortic stenosis?
Cohort (n=622)
Does left atrial size predict mortality and symptom development in asymptomatic patients with severe aortic stenosis?
Left atrial diameter is an independent predictor of mortality in asymptomatic patients with severe aortic stenosis, suggesting its utility in risk stratification.
Answers are grounded in this paper and cite their sources.
May refine mortality risk stratification in asymptomatic severe AS; leaves open prospective validation for symptoms and intervention timing.
BACKGROUND: We assessed the hypothesis that diastolic function represented by left atrial size determines the rate of development of symptoms and the risk of all-cause mortality in asymptomatic patients with severe aortic stenosis (AS). METHODS: From a database of 622 asymptomatic patients with isolated severe AS (velocity by Doppler >or= 4 m/sec) followed for 5.4 +/- 4 years, we reviewed the echocardiograms and evaluated Doppler echocardiographic indices of diastolic function. Prediction of symptom development and mortality by left atrial diameter with and without adjusting for clinical and echocardiographic parameters was performed using Cox proportional-hazards regression analysis. RESULTS: The age was 71 +/- 11 years and 317 (62%) patients were males. The aortic valve mean gradient was 46 +/- 11 mmHg, and the Doppler-derived aortic valve area was 0.9 +/- 0.2 cm(2). During follow-up, symptoms developed in 233 (45%), valve surgery was performed in 290 (57%) and 138 (27%) died. Left atrial enlargement was significantly correlated with symptom development (P < 0.05) but the association diminished after adjusting for aortic valve area and peak velocity (P = 0.2). However, atrial diameter predicted death independent of age and gender (P = 0.007), comorbid conditions (P = 0.03), and AS severity and Doppler parameters of diastolic function (P = 0.002). CONCLUSION: Diastolic function, represented as left atrial diameter, is related to mortality in asymptomatic patients with severe AS.
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Casaclang‐Verzosa et al. (2010) conducted a cohort in Asymptomatic severe aortic stenosis (n=622). Left atrial diameter was evaluated on All-cause mortality (p=0.002). Left atrial diameter predicted all-cause mortality independent of AS severity and Doppler parameters of diastolic function in asymptomatic patients with severe aortic stenosis.
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