The prognostic role of left atrial deformation in aortic stenosis

Abstract Introduction Aortic stenosis is the most common valvular heart disease in developed countries.It leads to complex structural changes in the heart including left ventricular hypertrophy, conduction abnormalities and heart failure.While survival in asymptomatic patients is similar to matched control groups, it decreases rapidly with the onset of symptoms. This makes early diagnosis and intervention important.Early diagnosis and intervention have been shown to improve outcomes. Echocardiography is the main imaging modality and left atrial deformation is one of the most sensitive indicators of left atrial dynamics.Speckle tracking echocardiography, a novel imaging modality, allows for assessment of atrial strain and has shown prognostic value in conditions such as heart failure and atrial fibrillation. This study investigates the prognostic value of left atrial strain parameters in patients with aortic stenosis and evaluates their relationship with survival outcomes. Methods Echocardiographic images of the enrolled patients were obtained and analyzed retrospectively.Patient medical histories and outpatient follow-up records were reviewed, and survival data were collected via hospital records. The follow-up period is from the date of echocardiographic diagnosis to the last point of contact. The study endpoints included all-cause mortality and heart failure related hospitalizations. Statistical analyses included t-tests and multivariable linear regression and Cox regression analysis. Results The study included 483 patients (mean age:59 ± 10 year,male:59%).Over a median follow-up period of 5.7 years (interquartile range: 1.2–7.6 years), 41 patients (8.4%) died, and 64 patients (13.2%) were hospitalized due to heart failure. Aortic valve replacement was performed in 113 patients (23.4%).Patients who died or were hospitalized had significantly lower left atrial reservoir (27.1 ± 6.2% vs. 30.2 ± 7.2%), conduit (13.7 ± 4.2% vs. 16.2 ± 4.7%), and contraction strain (13.4 ± 3.8% vs. 14.1 ± 4.1%) compared to those without adverse outcomes (all p 0.05). Age, left ventricular global longitudinal strain, and left atrial reservoir strain were found as independent predictors of adverse outcomes. Patients were stratified into two groups based on a cut-off value of 28% for left atrial reservoir strain. A left atrial reservoir strain value below 29% was associated with a 2.55-fold increased risk of mortality and hospitalization (Logrank p0.001, HR 3.17 CI%95 2.08-4.85)(Figure 1). Conclusion Left atrial strain measurements, particularly reservoir strain, provide valuable prognostic information in patients with aortic stenosis. These findings suggest that in addition to conventional echocardiographic parameters, assessment of left atrial strain measurements can enhance clinical risk stratification and patient management.Figure 1