Going beyond classic echo in aortic stenosis: left atrial mechanics, a new marker of severity
Abstract Background There is limited information regarding left atrial (LA) mechanics in aortic valve stenosis (AS). We assessed LA mechanics in AS through speckle-tracking echocardiography (STE) according to severity and prognosis. Methods We included 102 patients diagnosed with severe AS (sAS) and...
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doaj-653b6394563a4fe1ab6770dc4608a7a12020-11-25T03:57:23ZengBMCBMC Cardiovascular Disorders1471-22612019-10-011911810.1186/s12872-019-1204-2Going beyond classic echo in aortic stenosis: left atrial mechanics, a new marker of severityPatrícia Marques-Alves0Ana Vera Marinho1Rogério Teixeira2Rui Baptista3Graça Castro4Rui Martins5Lino Gonçalves6Department of Cardiology, Centro Hospitalar e Universitário de CoimbraDepartment of Cardiology, Centro Hospitalar e Universitário de CoimbraDepartment of Cardiology, Centro Hospitalar e Universitário de CoimbraDepartment of Cardiology, Centro Hospitalar e Universitário de CoimbraDepartment of Cardiology, Centro Hospitalar e Universitário de CoimbraDepartment of Cardiology, Centro Hospitalar e Universitário de CoimbraDepartment of Cardiology, Centro Hospitalar e Universitário de CoimbraAbstract Background There is limited information regarding left atrial (LA) mechanics in aortic valve stenosis (AS). We assessed LA mechanics in AS through speckle-tracking echocardiography (STE) according to severity and prognosis. Methods We included 102 patients diagnosed with severe AS (sAS) and 80 patients with moderate AS (mAS), all with preserved ejection fraction and no coronary artery disease. LA mechanics and left ventricular global longitudinal strain (LV-GLS) were assessed by STE. The cohort was followed-up for a median of 30 (IQR 12.6–50) months, and outcomes were determined (combined outcome of HF, death, and aortic valve replacement). Results In our sample set, values of LV-GLS (− 18.5% vs − 17.1, p = 0.025), E/e’ ratio (15.8 vs 18.4, p = 0.03), and global LA mechanics (LA ɛsys, 23% vs 13.8%, p < 0.001) were worse for sAS compared to those for mAS. However, LA ɛsys (AUC 0.85, 95% CI 0.78–0.90, p < 0.001), ɛe (AUC 0.83, 95% CI 0.75–0.88, p < 0.001), and ɛa (AUC 0.80, 95% CI 0.70–0.84, p < 0.001) were the best discriminators of sAS, with sensitivities higher than 85%. LA ɛsys showed a stronger correlation with both aortic valve area (r 2 = 0.6, p < 0.001) and mean LV/aortic gradient (r 2 = 0.55, p < 0.001) than LV-GLS (r 2 = 0.3 and r 2 = 0.25, p = 0.01). Either LV-GLS or LA ɛsys, but not the E/e’ ratio, TAPSE, or RV/RA gradient, were a significant predictors of the combined outcome. Conclusions LA global strain was the best discriminator of severity, surpassing E/e’ ratio and LV-GLS, and a significant predictor of prognosis in AS.http://link.springer.com/article/10.1186/s12872-019-1204-2Aortic stenosisatrial mechanicstwo-dimensional speckle-tracking strain |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Patrícia Marques-Alves Ana Vera Marinho Rogério Teixeira Rui Baptista Graça Castro Rui Martins Lino Gonçalves |
spellingShingle |
Patrícia Marques-Alves Ana Vera Marinho Rogério Teixeira Rui Baptista Graça Castro Rui Martins Lino Gonçalves Going beyond classic echo in aortic stenosis: left atrial mechanics, a new marker of severity BMC Cardiovascular Disorders Aortic stenosis atrial mechanics two-dimensional speckle-tracking strain |
author_facet |
Patrícia Marques-Alves Ana Vera Marinho Rogério Teixeira Rui Baptista Graça Castro Rui Martins Lino Gonçalves |
author_sort |
Patrícia Marques-Alves |
title |
Going beyond classic echo in aortic stenosis: left atrial mechanics, a new marker of severity |
title_short |
Going beyond classic echo in aortic stenosis: left atrial mechanics, a new marker of severity |
title_full |
Going beyond classic echo in aortic stenosis: left atrial mechanics, a new marker of severity |
title_fullStr |
Going beyond classic echo in aortic stenosis: left atrial mechanics, a new marker of severity |
title_full_unstemmed |
Going beyond classic echo in aortic stenosis: left atrial mechanics, a new marker of severity |
title_sort |
going beyond classic echo in aortic stenosis: left atrial mechanics, a new marker of severity |
publisher |
BMC |
series |
BMC Cardiovascular Disorders |
issn |
1471-2261 |
publishDate |
2019-10-01 |
description |
Abstract Background There is limited information regarding left atrial (LA) mechanics in aortic valve stenosis (AS). We assessed LA mechanics in AS through speckle-tracking echocardiography (STE) according to severity and prognosis. Methods We included 102 patients diagnosed with severe AS (sAS) and 80 patients with moderate AS (mAS), all with preserved ejection fraction and no coronary artery disease. LA mechanics and left ventricular global longitudinal strain (LV-GLS) were assessed by STE. The cohort was followed-up for a median of 30 (IQR 12.6–50) months, and outcomes were determined (combined outcome of HF, death, and aortic valve replacement). Results In our sample set, values of LV-GLS (− 18.5% vs − 17.1, p = 0.025), E/e’ ratio (15.8 vs 18.4, p = 0.03), and global LA mechanics (LA ɛsys, 23% vs 13.8%, p < 0.001) were worse for sAS compared to those for mAS. However, LA ɛsys (AUC 0.85, 95% CI 0.78–0.90, p < 0.001), ɛe (AUC 0.83, 95% CI 0.75–0.88, p < 0.001), and ɛa (AUC 0.80, 95% CI 0.70–0.84, p < 0.001) were the best discriminators of sAS, with sensitivities higher than 85%. LA ɛsys showed a stronger correlation with both aortic valve area (r 2 = 0.6, p < 0.001) and mean LV/aortic gradient (r 2 = 0.55, p < 0.001) than LV-GLS (r 2 = 0.3 and r 2 = 0.25, p = 0.01). Either LV-GLS or LA ɛsys, but not the E/e’ ratio, TAPSE, or RV/RA gradient, were a significant predictors of the combined outcome. Conclusions LA global strain was the best discriminator of severity, surpassing E/e’ ratio and LV-GLS, and a significant predictor of prognosis in AS. |
topic |
Aortic stenosis atrial mechanics two-dimensional speckle-tracking strain |
url |
http://link.springer.com/article/10.1186/s12872-019-1204-2 |
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