Prognostic implications of left atrial dilation in aortic regurgitation due to bicuspid aortic valve

Abstract

ObjectiveTo investigate the prognostic value of left atrial volume index (LAVI) in patients with moderate to severe aortic regurgitation (AR) and bicuspid aortic valve (BAV).Methods554 individuals (45 (IQR 33–57) years, 80% male) with BAV and moderate or severe AR were selected from an international, multicentre registry. The association between LAVI and the combined endpoint of all-cause mortality or aortic valve surgery was investigated with Cox proportional hazard regression analyses.ResultsDilated LAVI was observed in 181 (32.7%) patients. The mean indexed aortic annulus, sinus of Valsalva, sinotubular junction and ascending aorta diameters were 13.0±2.0 mm/m2, 19.4±3.7 mm/m2, 16.5±3.8 mm/m2 and 20.4±4.5 mm/m2, respectively. After a median follow-up of 23 (4–82) months, 272 patients underwent aortic valve surgery (89%) or died (11%). When compared with patients with normal LAVI (<35 mL/m2), those with a dilated LAVI (≥35 mL/m2) had significantly higher rates of aortic valve surgery or mortality (43% and 60% vs 23% and 36%, at 1 and 5 years of follow-up, respectively, p<0.001). Dilated LAVI was independently associated with reduced event-free survival (HR=1.450, 95% CI 1.085 to 1.938, p=0.012) after adjustment for LV ejection fraction, aortic root diameter, LV end-diastolic diameter and LV end-systolic diameter.ConclusionsIn this large, multicentre registry of patients with BAV and moderate to severe AR, left atrial dilation was independently associated with reduced event-free survival. The role of this parameter for the risk stratification of individuals with significant AR merits further investigation.

Blood and Imaging Biomarkers in the Long-term Follow-up of Bicuspid Aortic Valve Patients

“…A recent large registry study showed the prognostic importance of LA dilatation in patients with BAV and moderate or severe aortic regurgitation. 26 In our study, LA enlargement also showed a significant prognostic association with arrhythmia-free survival, as did E/e’ ratio and LV mass index. GLS and LVEF were not associated with arrhythmia-free survival.…”

Cardiac Imaging for the Assessment of Left Atrial Mechanics Across Heart Failure Stages

“…A direct correlation between LA reservoir function and PH has been reported in patients with moderate or severe AR, with a 6% increase of PH risk for each unit of LA strain decrease ( 151 ). Recently, a large study on 554 patients with bicuspid aortic valve and moderate or severe AR showed that the LA enlargement (LAVI ≥ 35 ml/m 2 ) was independently associated with adverse outcome (aortic valve surgery or mortality), when compared with patients with normal LAVi (43 and 60% vs. 23 and 36%, at 1 and 5 years of follow-up, respectively, p < 0.001) ( 161 ). In addition to LA enlargement, its contractile function is impaired in severe AR, as reported in 65 patients scheduled for AVR and assessed with 2DSTE.…”

Analysis of Prevalence and Clinical Features of Aortic Stenosis in Patients with and without Bicuspid Aortic Valve Using Machine Learning Methods

“…Additionally, aortic regurgitation (AR) was identified as a predictor of AS regardless of valve morphology, and varying degrees of AR was detected in one in four patients with BAV. Other studies have also reported the incidence of AR in patients with BAV to range from 13 to 65% [34,35]. Statistically, the median ejection fraction (EF) was within the normal range.…”