Left atrial dysfunction as a determinant of pulmonary hypertension in patients with severe aortic stenosis and preserved left ventricular ejection fraction

Abstract

In patients with severe aortic stenosis (AS), the presence of pulmonary hypertension (PH) has been linked to a poor prognosis. We aimed to assess the main determinants of PH in patients with severe AS and preserved left ventricular ejection fraction (LVEF). We prospectively enrolled 108 consecutive patients with isolated severe AS (indexed aortic valve area <0.6 cm/m) and LVEF >50%, in sinus rhythm. Left atrial (LA) function was assessed using longitudinal deformation parameters (by speckle tracking echocardiography). PH (defined as systolic pulmonary artery pressure >40 mmHg) was present in 20 patients. Patients with severe AS and PH were older (p = 0.05), had higher BNP values (p = 0.05) and a greater degree of LV diastolic dysfunction: higher E/e' and E/A ratios and lower EDT values (p < 0.03 for all) compared to patients without PH. There were no differences between groups regarding AS severity and LV systolic function parameters. Patients with PH had a more impaired LA function: lower septal and lateral late diastolic peak velocity a' (p < 0.001 and p = 0.04 respectively) and lower LA peak longitudinal strain and strain rate parameters (p ≤ 0.005 for all). In multivariable analysis, LA late diastolic longitudinal strain rate was the only independent correlate of PH in our patients (p = 0.04). Patients with isolated severe AS, preserved LVEF and PH had larger LA volumes, a more impaired LA function, and higher LV filling pressures compared to those without PH. LA booster pump function, reflected by late diastolic longitudinal strain rate, emerged as an independent correlate of PH in these patients.

Assessment of the Right and Left Atrial Functions at Midterm After Surgical and Device Atrial Septal Defect Closure: A 2‐Dimensional Speckle‐Tracking Echocardiographic Study

“…Previous research has highlighted the prognostic and clinical values of the LA and RA functions as evaluated with 2D speckle‐tracking echocardiography in some conditions . Two‐dimensional speckle‐tracking echocardiography is an assessment method for atrial functions and can detect atrial dysfunction, however subtle …”

“…Previous research has highlighted the prognostic and clinical values of the LA and RA functions as evaluated with 2D speckle-tracking echocardiography in some conditions. [21][22][23][24] Two-dimensional speckle-tracking echocardiography is an assessment method for atrial functions 11,12 and can detect atrial dysfunction, however subtle. 25,26 To our knowledge, our study is the first of its kind to compare the RA and LA functions as assessed with 2D speckle-tracking echocardiography both between patients having undergone device and surgical ASD closure 1 to 5 years previously and between them and a healthy control group.…”

Pulmonary Hypertension in Aortic and Mitral Valve Disease

“…In general there is an association between higher sPAP and more severe AS as expressed by lower aortic valve area (AVA) ( 14, 28 ) and lower LVEF ( 14, 28, 35 ). However, PH is common also in patients with normal or only mildly reduced LVEF, where LV diastolic dysfunction ( 17 ), LA dilatation ( 23, 28, 35 ) and dysfunction ( 69 ), atrial fibrillation ( 14 ), concomitant MR ( 14, 23 ) and comorbidities including lung disease ( 17 ), obesity ( 27 ), anemia ( 27 ), and renal failure ( 27 ) are key determinants of PH. The majority of studies used echocardiography to assess the presence of PH, and thus the exact hemodynamics c remain unknown.…”

The role of the left atrial function in the surgical management of aortic and mitral valve disease

“…The authors report no relationships that could be construed as a conflict of interest. • Predictive of MACE 18 • Predictive of post-operative AF 19,20 • Main determinant of PH, in presence of preserved LVEF 22,23 • Correlation with LA reverse remodeling 31 • Inverse correlation with atrial fibrosis 33 • Correlation with PH, symptoms and AF 33 • Important prognostic factor 39 Abbreviations: AF = atrial fibrillation; HF = heart failure; LA = left atrial; LAAV = left atrial appendage velocity; LAS = left atrial strain; LASr = leaf atrial strain during reservoir phase; LVEF = left ventricular ejection fraction; MACE = major adverse cardiovascular events; PH = pulmonary hypertension.…”