Left atrial strain and distensibility in relation to left ventricular dysfunction and prognosis in aortic stenosis

Abstract

Objective To test the relationship between left atrial (LA) distensibility (LAD), LA strain (LAS), and left ventricular (LV) dysfunction and prognosis in aortic stenosis (AS). Methods Transthoracic Doppler echocardiography was performed prospectively in 102 consecutive patients with AS (77 with severe, 25 with moderate, mean age 77 years). LA volume was calculated by the area‐length method in apical four‐ and two‐chamber views, immediately before mitral valve opening (Volmax) and at mitral valve closure (Volmin). LAD was defined as (Volmax – Volmin) × 100%/Volmin. LAS (mean of maximal strain from the 4–2 chamber views) was conducted using a dedicated software package. The endpoint was hospitalization for heart failure and death from any cause. Results Left atrial strain, LAD, and LA vol/m² were significantly correlated with LV diastolic parameters, and PASP (all, P < 0.05). However, LAD and LAS but not LA vol/m² were significantly correlated with Charlson score, LV global longitudinal strain, and to transaortic mean gradient (all, P < 0.05). At a median follow‐up of 25 months, 53 patients had an event. LAS, LAD, LA vol/m², and Charlson index were associated with events (all, P < 0.05). In multivariate analysis, LAD, LAS, and Charlson index (all, P < 0.01) remained independently associated with events. Using a ROC curve analysis, LAD ≤ 69% and LAS ≤ 17% were the best cutoffs associated with an event. Conclusion In patients with moderate to severe AS, LAD and LAS are associated with LV dysfunction, AS severity, and are independently linked to events.

Multi-modality assessment and role of left atrial function as an imaging biomarker in cardiovascular disease

“…Non-invasive imaging modalities have assessed LA deformation for initial diagnosis [ 25 , 44 – 47 ], prognostic assessment [ 48 – 51 ], and evaluation of treatment response across different disease states [ 52 – 55 ]. Cardiac deformation analysis using strain and strain rate (SR) imaging allows early detection of pre-clinical cardiac disease.…”

Prognostic value of left atrial strain in patients with congenital aortic stenosis

“…Additionally, the mean age of our patients was younger than the patient cohorts in the similar studies, which enrolled mainly AS patients with degenerative aetiology. 8 , 10 , 16 A younger patient cohort with different pathophysiology (congenital vs. degenerative) and less severe disease most probably resulted in similar LA volumes.…”

“… 7 Previous studies have shown that LA functional impairment might be present even when no structural changes are observed and might be an earlier indicator of cardiac damage in patients with AS. 8 , 9 As a result, an assessment of LA functions in asymptomatic patients might be more sensitive in predicting outcomes in CAS patients compared with an assessment of structure.…”

Left atrial strain in cardiovascular diseases : An overview of clinical applications

“…Since LA functional impairment appears to occur earlier than LA dilatation in AS, PALS could be used to identify early damage also in this setting. In fact, PALS showed to be correlated with prognosis in patients with several degrees of AS (50,51), and with the development of post-operative AF caused by fibrosis, increased myocardial stiffness, and altered relaxation ( 52), also regardless of pre-existing LA dilatation (53). Also, LA strain was the major determinant of PH in patients with severe AS and preserved LVEF (54) and a marker of LA remodeling after transcatheter aortic valve replacement (55), suggesting that a serial evaluation of LA function in these patients could help providing early surgical treatment also in AS before the development of PH and irreversible LA damage.…”