Key result
Elevated left atrial stiffness index linked to ~4.2-fold higher odds of ascending aortic dilatation in BAV.
Why the study?
The relationships of left atrial strain parameters and left atrial stiffness index (LASI) with ascending aortic dilatation (AAD) in patients with bicuspid aortic valve (BAV), as well as their ability to discriminate between BAV patients with and without AAD, remained unclear.
Does the echocardiographic left atrial stiffness index (LASI) discriminate the presence of ascending aortic dilatation in patients with bicuspid aortic valve and preserved ejection fraction?
Cross-Sectional (n=126)
No
Does the echocardiographic left atrial stiffness index (LASI) discriminate the presence of ascending aortic dilatation in patients with bicuspid aortic valve and preserved ejection fraction?
Left atrial stiffness index (LASI) is independently associated with ascending aortic dilatation in patients with bicuspid aortic valve and provides incremental discriminatory value beyond left atrial reservoir strain and E/e′.
Answers are grounded in this paper and cite their sources.
LASI >0.30 may discriminate aortic dilatation in bicuspid aortic valve; leaves open prospective validation before clinical adoption.
Background Left atrial stiffness index (LASI) is an emerging echocardiographic index that reflects left atrial–left ventricular functional coupling and diastolic dysfunction. However, the relationships of left atrial strain parameters and LASI with ascending aortic dilatation (AAD) in patients with bicuspid aortic valve (BAV) remain unclear. This study aimed to investigate the associations of left atrial strain parameters and LASI with the presence of AAD and to evaluate their ability to discriminate between BAV patients with and without AAD. Methods and results This retrospective study included 86 patients with BAV and 40 healthy controls. Left atrial reservoir strain (LASr), conduit strain (LAScd), and contraction strain (LASct) were measured, and LASI was calculated. Based on the aortic size index (ASI), patients with BAV were classified into a nondilated group (ASI ≤ 2.1 cm/m 2 ) and a dilated group (ASI > 2.1 cm/m 2 ). In ROC curve analyses, LASr, E/e′ (the ratio of early transmitral flow velocity to early diastolic mitral annular velocity), and LASI demonstrated discriminatory ability for the presence of AAD in patients with BAV, with AUCs of 0.792, 0.783, and 0.871, respectively. The corresponding data-derived optimal cutoff values were 23.44%, 8.17, and 0.30. Multivariable binary logistic regression analysis showed that LASr < 23.44%, E/e′ > 8.17, and LASI > 0.30 were independently associated with the presence of AAD in patients with BAV. When LASI was added to the baseline model comprising E/e′ and LASr, the likelihood-ratio χ 2 increased from 41.88 to 45.84 ( Δχ 2 = 3.96, P = 0.047), with a continuous net reclassification improvement of 0.571 (95% CI, 0.193–0.950; P = 0.003). Conclusions LASI was associated with the presence of AAD in patients with BAV and provided incremental discriminatory information within the study sample. As a simple echocardiographic index integrating an estimate of left ventricular filling pressure with left atrial reservoir function, LASI may provide complementary information on left atrial–left ventricular functional alterations in BAV patients with AAD.
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Liu et al. (2026) conducted a cross-sectional in Bicuspid aortic valve (BAV) with or without ascending aortic dilatation (AAD) (n=126). Left atrial stiffness index (LASI) > 0.30 vs. LASI ≤ 0.30 was evaluated on Presence of ascending aortic dilatation (aortic size index > 2.1 cm/m2) in patients with bicuspid aortic valve (OR 4.16, 95% CI 1.02-17.03, p=0.048). Left atrial stiffness index >0.30 was independently associated with ascending aortic dilatation in bicuspid aortic valve patients with an AUC of 0.871.
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