Prognostic value of pre-operative left atrial strain on composite endpoint in patients received aortic valve replacement for severe aortic stenosis: a retrospective cohort study

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Objective Severe aortic stenosis (AS) is the most common primary valvular heart disease, treatable only by aortic valve replacement (AVR). Current literatures have shown that severe AS may precede atrial dysfunction which predicts adverse outcomes. However, predictive value of pre-operative left atrial (LA) function on post-AVR clinical outcomes is uncertain. The study aims to evaluate the prognostic value of pre-operative LA strain on post AVR all-cause mortality and heart failure. Methods Patients aged 18 years old or above with severe AS were recruited and assessed using speckle-tracking echocardiography pre-operatively. Severe AS was defined according to 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease. Peak Atrial Longitudinal Strain (PALS) was measured as a surrogate of LA function. Patients with underlying pre-operative atrial fibrillation and other severe valvular heart diseases were excluded. High PALS was defined as PALS higher than 15.94%. Patients were followed up until death or end of the study. The primary endpoint is a composite endpoint of all-cause mortality and heart failure during hospitalisation. The association of LA function with composite endpoint of all-cause mortality and heart failure was evaluated by Cox Proportional Hazards analysis. Results A total of 128 patients (mean age 65.3.9 ± 9.4 years, 56.3% male) were analysed. Patients were followed up for a mean period of 3.9 ± 2.4years. A total of 65 of 128 patients (50.8%) belonged to low PALS group. During the study period, 23 patients developed events on the composite endpoint. Among those with composite endpoint, low PALS group accounted for 18 (78.3%) patients and high PALS group accounted for 5 (21.7%) patients. Higher PALS was independently associated with lower risk of composite endpoint of all-cause mortality and heart failure (HR, 0.33; 95% CI 0.117-0.916, p = 0.03) after adjustment for EuroSCORE II. Conclusion Higher PALS, a surrogate of LA function, is associated with a lower risk of composite endpoints of mortality and heart failure in patients with severe AS undergoing AVR, independent of EuroSCORE II. Evaluation of LA function by assessing speckle tracking derived PALS may aid in prognostication for patients undergoing AVR.