The left atrium remodeling is associated with adverse outcomes in unoperated degenerative aortic stenosis

Abstract

Degenerative aortic stenosis (DAS) may be accompanied by remodeling of the left atrium (LA). The aim of the study was to assess the effect of the morpho-functional parameters of the LA remodeling on the prognosis of patients with DAS. The prospective study included 383 patients (men – 33.9% of patients), aged 78.9 ± 0.40 years, with DAS (mild – 18.3%, moderate – 30.8%, severe – 50.9%). The patients did not undergo a surgical correction of the defect. The LA morpho-functional state was estimated by the LA size/volume and the ratio of the rate of the transmitral flow to the rate of the early diastolic movement of the fibrous mitral valve ring (E/e ratio). The average follow-up period was 603.9 ± 24.57 days. The general mortality was assessed. The information on the outcomes was collected by telephone contacts. Multivariate Сox-regression analyses showed that the LA remodeling was independently associated with the death risk: an increase in the LA size ≥45 mm (ОR 1.6, CI 1.06-2.37, р=0.026) and an increase in the Е/е ratio >15 (ОR 1.6, CI 1.08-2.39, р=0.021). Another risk factor was a decrease in the creatinine clearance <45 ml/min (ОR 1.7, CI 1.10-2.60, р=0.016), area of the aortic valve (ОR 0.4, CI 0.26-0.74, р=0.002) and a decrease in the left ventricular ejection fraction <40% (ОR 1.7, CI 1.02-2.71, р=0.042). The Kaplan-Meier survival analysis showed that the E/e ratio>15 and the LА size ≥45 mm were statistically significantly associated with an increased risk of the general mortality (р<0.0001, LogRank=14.5 and р<0.0001, LogRank=18.2, respectively). The areas under the ROC curves for the increased LA size ≥45 mm and the E/e ratio>15 were 0.62 and 0.61, respectively. Thus, the indices of the LA remodeling – the LA size ≥45 mm and the E/e ratio > 15 – are associated with a poor outcome in patients with DAS.