Abstract
BackgroundThere is limited information regarding left atrial (LA) mechanics in aortic valve stenosis (AS). We assessed LA mechanics in AS through speckle-tracking echocardiography (STE) according to severity and prognosis.MethodsWe included 102 patients diagnosed with severe AS (sAS) and 80 patients with moderate AS (mAS), all with preserved ejection fraction and no coronary artery disease. LA mechanics and left ventricular global longitudinal strain (LV-GLS) were assessed by STE. The cohort was followed-up for a median of 30 (IQR 12.6–50) months, and outcomes were determined (combined outcome of HF, death, and aortic valve replacement).ResultsIn our sample set, values of LV-GLS (− 18.5% vs − 17.1, p = 0.025), E/e’ ratio (15.8 vs 18.4, p = 0.03), and global LA mechanics (LA ɛsys, 23% vs 13.8%, p < 0.001) were worse for sAS compared to those for mAS. However, LA ɛsys (AUC 0.85, 95% CI 0.78–0.90, p < 0.001), ɛe (AUC 0.83, 95% CI 0.75–0.88, p < 0.001), and ɛa (AUC 0.80, 95% CI 0.70–0.84, p < 0.001) were the best discriminators of sAS, with sensitivities higher than 85%. LA ɛsys showed a stronger correlation with both aortic valve area (r2 = 0.6, p < 0.001) and mean LV/aortic gradient (r2 = 0.55, p < 0.001) than LV-GLS (r2 = 0.3 and r2 = 0.25, p = 0.01). Either LV-GLS or LA ɛsys, but not the E/e’ ratio, TAPSE, or RV/RA gradient, were a significant predictors of the combined outcome.ConclusionsLA global strain was the best discriminator of severity, surpassing E/e’ ratio and LV-GLS, and a significant predictor of prognosis in AS.
Highlights
There is limited information regarding left atrial (LA) mechanics in aortic valve stenosis (AS)
LA ɛsys (AUC 0.85, 95% Confidence interval (CI) 0.78–0.90, p < 0.001), ɛe (AUC 0.83, 95% CI 0.75–0.88, p < 0.001), and ɛa (AUC 0.80, 95% CI 0.70–0.84, p < 0.001) were the best discriminators of severe AS (sAS), with sensitivities higher than 85%
LA global strain was the best discriminator of severity, surpassing E/e’ ratio and left ventricular (LV)-GLS, and a significant predictor of prognosis in AS
Summary
There is limited information regarding left atrial (LA) mechanics in aortic valve stenosis (AS). We assessed LA mechanics in AS through speckle-tracking echocardiography (STE) according to severity and prognosis. Aortic valve stenosis (AS) is currently the most common valvular heart disease, and its prevalence is increasing as the population ages [1]. In patients with aortic valve disease, the left atrium (LA) undergoes remodeling due to pressure overload, resulting in disturbances in three functional phases: reservoir, conduit, and contractile phase [3, 4]. In patients with AS, there is an increase in Speckle-tracking echocardiographic (STE) analysis allows a rapid and practical assessment of the atrial deformation profile, due to its semiautomated system and offline processing [4, 7]. In sAS, atrial function is an independent predictor of postoperative
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