Incremental prognostic role of left atrial reservoir strain in asymptomatic patients with moderate aortic stenosis
- 31 May 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in The International Journal of Cardiovascular Imaging
- Vol. 37 (6), 1913-1925
- https://doi.org/10.1007/s10554-021-02175-6
Abstract
Left atrial (LA) mechanics assessed by two-dimensional speckle tracking echocardiography (2D-STE) have not been extensively studied and clearly characterized in patients with moderate aortic stenosis (AS). Accordingly, we aimed to evaluate the usefulness of LA reservoir strain for risk stratification of asymptomatic patients with moderate AS. This retrospective study included all consecutive asymptomatic patients with moderate AS who underwent transthoracic echocardiography implemented with 2D-STE analysis of LA myocardial strain and strain rate indices at our Institution, between February 2011 and September 2019. During the follow-up period, we evaluated the occurrence of any of the following: (1) CV hospitalization; (2) The recourse to AS surgery; (3) Cardiac death or sudden death. A total of 186 patients (mean age 71.9 +/- 12.7 years, 61.8% men) were included in the present study. During a mean follow-up of 2.3 +/- 1.9 years, no patients died and 63 adverse CV events were recorded: 48 patients were hospitalized because of heart failure (28 patients), acute coronary syndrome (10 patients), arrhythmias (10 patients) and 15 patients underwent AS surgery. At the multivariate Cox regression analysis, type 2 diabetes mellitus (OR 1.87, 95%CI 1.05-3.34, p = 0.03), NT-proBNP (OR average 1.14, 95%CI 1.02-1.27, p = 0.02), average E/e ' ratio (OR 1.07, 95%CI 1.01-1.15, p = 0.04) and most of all left atrial positive global strain (LA-GSA+) (OR 0.85, 95%CI 0.81-0.90, p < 0.0001) were independently associated with the outcome. LA-GSA+ (optimal cut-off <= 19%, AUC = 0.94, 87% sensitivity, 99% specificity, positive predictive value 99%, negative predictive value 88%) showed the highest diagnostic performance. An impaired LA reservoir strain can contribute to identify a subset of asymptomatic patients with moderate AS at higher risk, who may benefit from closer echocardiographic follow-up and/or early surgery.This publication has 61 references indexed in Scilit:
- Does Diabetes Accelerate the Progression of Aortic Stenosis through Enhanced Inflammatory Response within Aortic valves?Inflammation, 2011
- Prognostic effect of inappropriately high left ventricular mass in asymptomatic severe aortic stenosisHeart, 2010
- Aortic Valve CalcificationArteriosclerosis, Thrombosis, and Vascular Biology, 2007
- Abnormalities of left atrial function after cardioversion: an atrial strain rate studyHeart, 2007
- Age- and Gender-Related Ventricular-Vascular StiffeningCirculation, 2005
- Natriuretic Peptides Predict Symptom-Free Survival and Postoperative Outcome in Severe Aortic StenosisCirculation, 2004
- Mild and moderate aortic stenosis Natural history and risk stratification by echocardiographyEuropean Heart Journal, 2004
- Predictors of Outcome in Severe, Asymptomatic Aortic StenosisThe New England Journal of Medicine, 2000
- Natural history of moderate aortic stenosisJournal of the American College of Cardiology, 1991
- Echocardiographic assessment of left ventricular hypertrophy: Comparison to necropsy findingsThe American Journal of Cardiology, 1986