Left atrial volume index in patients with asymptomatic severe aortic stenosis

The proper timing for aortic valve surgery in the asymptomatic patient with severe aortic stenosis (AS) remains challenging. The aim of this study was to determine the left atrial volume index (LAVI) in asymptomatic patients with severe AS in comparison to symptomatic severe AS patients and its relation to the degree of left ventricular (LV) hypertrophy and tissue Doppler measures of LV diastolic function. Thirty-four patients with severe AS and preserved LV function, divided into two groups were studied. Group I comprised 17 patients with symptomatic severe AS, and Group II comprised 17 patients with asymptomatic severe AS. Echocardiographic assessment of LV dimension, function, and calculation of LV mass were done. LA volume index was obtained by the biplane Simpson method. Transmitral E, A diastolic velocities, deceleration time (DT) and E/A ratio were measured. Peak S′, early (E′) and late (A′) diastolic velocities of the lateral mitral annulus were measured by tissue Doppler imaging. LAVI was significantly higher in symptomatic compared to asymptomatic patients with severe AS (p < 0.0001). LAVI with a cutoff point of 39.5 ml/m2 was a predictor of symptoms in patients with severe AS yielded an area under the curve of 0.958, P < 0.0001, with a sensitivity of 94% and specificity of 89%. LAVI had a significant positive correlation with left ventricular mass (p < 0.014), right ventricular systolic pressure (RVSP) (p < 0.009), mitral peak E (p < 0.025), and E/E′ (p < 0.008). Multiple linear regression analysis revealed that LV mass (p < 0.0001) and E/E′ (p < 0.0001) were the independent predictors of increased LAVI in severe AS. Left atrial volume index can predict symptoms in patients with asymptomatic severe AS. Left ventricular mass and E/E′ were the independent predictors of increased LAVI.