Abstract
BackgroundAortic valve stenosis (AS) is the most common primary valvular heart disease leading to surgical or percutaneous aortic valve replacement (AVR) in Europe and its prevalence keeps growing. While other risk factors in severe AS are well documented, little is known about the prognostic value of left atrial (LA) function in AS. Our aim is to clarify the relationship between LA function measured at severe AS diagnosis (evaluated by means of volumetric assessment) and all-cause mortality during follow-up.MethodsWe retrospectively evaluated patients diagnosed with severe AS for the first time at our echocardiography laboratory. We evaluated LA reservoir, conduit and pump function by measuring LA volumes at different timings of cardiac cycle. Treatment strategy was decided according to heart team consensus and patient decision. We divided patients into groups according to terciles of LA reservoir, conduit and pump function. Primary outcome was defined by the occurrence of all-cause mortality during follow-up.ResultsA total of 408 patients were included in the analysis, with a median follow-up time of 45 months (interquartile range 54 months). 57.9% of patients underwent AVR and 44.9% of patients registered the primary outcome during follow-up. Left atrial emptying fraction (LAEF) was the best LA functional parameter and the best overall parameter in discriminating primary outcome (AUC 0.845, 95%CI 0.81–0.88, P < 0.001). After adjustment for clinical, demographic and echocardiographic variables, cumulative survival of patients with LAEF < 37% and LAEF 37 to 53% relative to patients with LAEF ≥54% remained significantly lower (HR 13.91, 95%CI 6.20–31.19, P < 0.001 and HR 3.40, 95%CI 1.57–7.37, P = 0.002, respectively). After adjustment for AVR, excess risk of LAEF < 37% and LAEF 37 to 53% relative to LAEF ≥54% remained significant (HR 11.71, 95%CI 5.20–26.40, P < 0.001 and HR 3.59, 95%CI 1.65–7.78, P = 0.001, respectively).ConclusionsIn patients with a first diagnosis of severe AS, LA function, evaluated by means of volumetric assessment, is an independent predictor of all-cause mortality and a more potent predictor of death compared to classical severity parameters. These data can be useful to identify high-risk patients who might benefit of AVR.
Highlights
Aortic valve stenosis (AS) is the most common primary valvular heart disease leading to surgical or percutaneous valve replacement in Europe and its prevalence keeps growing due to the generalized aging of population [1]
As we found aortic valve replacement (AVR) to interact with different terciles of Left atrial emptying fraction (LAEF), we performed a separate analysis for patients that underwent AVR and patients who did not underwent AVR
Subgroup analysis We found no interaction between age at diagnosis, body surface area (BSA), body mass index (BMI), arterial hypertension, presence of CAD, diabetes mellitus, previous symptomatic stroke/transient ischemic attack, Katz index of independence ≤4, atrial fibrillation (AF) appearance during follow-up, left ventricular ejection fraction (LVEF), right ventricular enlargement, tricuspid annular plane systolic excursion (TAPSE), very severe AS, E/e’, septal e’ velocity and the outcome impact of different LAEF terciles
Summary
Aortic valve stenosis (AS) is the most common primary valvular heart disease leading to surgical or percutaneous valve replacement in Europe and its prevalence keeps growing due to the generalized aging of population [1]. Aortic valve replacement (AVR) is indicated in the presence of symptoms and/or left ventricular systolic dysfunction [left ventricular ejection fraction (LVEF) < 50%] [2] Both symptoms and systolic dysfunction can appear late in the course of the disease, being often synonym of irreversible damage to the myocardium when found [3]. Aortic valve stenosis (AS) is the most common primary valvular heart disease leading to surgical or percutaneous aortic valve replacement (AVR) in Europe and its prevalence keeps growing. Our aim is to clarify the relationship between LA function measured at severe AS diagnosis (evaluated by means of volumetric assessment) and all-cause mortality during follow-up
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