Left atrial functional assessment and mortality in patients with severe aortic stenosis with sinus rhythm
Abstract Background 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. While other risk factors in severe AS are well documented, little is known about the prognos...
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doaj-160f02bb8e9f43a38a031154f4f19e252021-01-03T12:05:20ZengBMCCardiovascular Ultrasound1476-71202021-01-0119111210.1186/s12947-020-00231-0Left atrial functional assessment and mortality in patients with severe aortic stenosis with sinus rhythmJoão Ferreira0Valdirene Gonçalves1Patrícia Marques-Alves2Rui Martins3Sílvia Monteiro4Rogério Teixeira5Lino Gonçalves6Serviço de Cardiologia, Centro Hospitalar e Universitário de CoimbraServiço de Cardiologia, Centro Hospitalar e Universitário de CoimbraServiço de Cardiologia, Centro Hospitalar e Universitário de CoimbraServiço de Cardiologia, Centro Hospitalar e Universitário de CoimbraServiço de Cardiologia, Centro Hospitalar e Universitário de CoimbraServiço de Cardiologia, Centro Hospitalar e Universitário de CoimbraServiço de Cardiologia, Centro Hospitalar e Universitário de CoimbraAbstract Background 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. 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. Methods We 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. Results A 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). Conclusions In 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.https://doi.org/10.1186/s12947-020-00231-0Aortic stenosisAtrial mechanicsEchocardiographyBiomarkerPrognosis |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
João Ferreira Valdirene Gonçalves Patrícia Marques-Alves Rui Martins Sílvia Monteiro Rogério Teixeira Lino Gonçalves |
spellingShingle |
João Ferreira Valdirene Gonçalves Patrícia Marques-Alves Rui Martins Sílvia Monteiro Rogério Teixeira Lino Gonçalves Left atrial functional assessment and mortality in patients with severe aortic stenosis with sinus rhythm Cardiovascular Ultrasound Aortic stenosis Atrial mechanics Echocardiography Biomarker Prognosis |
author_facet |
João Ferreira Valdirene Gonçalves Patrícia Marques-Alves Rui Martins Sílvia Monteiro Rogério Teixeira Lino Gonçalves |
author_sort |
João Ferreira |
title |
Left atrial functional assessment and mortality in patients with severe aortic stenosis with sinus rhythm |
title_short |
Left atrial functional assessment and mortality in patients with severe aortic stenosis with sinus rhythm |
title_full |
Left atrial functional assessment and mortality in patients with severe aortic stenosis with sinus rhythm |
title_fullStr |
Left atrial functional assessment and mortality in patients with severe aortic stenosis with sinus rhythm |
title_full_unstemmed |
Left atrial functional assessment and mortality in patients with severe aortic stenosis with sinus rhythm |
title_sort |
left atrial functional assessment and mortality in patients with severe aortic stenosis with sinus rhythm |
publisher |
BMC |
series |
Cardiovascular Ultrasound |
issn |
1476-7120 |
publishDate |
2021-01-01 |
description |
Abstract Background 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. 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. Methods We 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. Results A 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). Conclusions In 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. |
topic |
Aortic stenosis Atrial mechanics Echocardiography Biomarker Prognosis |
url |
https://doi.org/10.1186/s12947-020-00231-0 |
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