Prognostic value of left atrial strain in patients with congenital aortic stenosis

Abstract

Aim To explore whether left atrial (LA) strain with speckle tracking echocardiography (STE) can contribute to prognostication in patients with congenital aortic stenosis (CAS). Methods In this prospective study, consecutive outpatients with stable CAS and healthy adults were enrolled between 2011-2015. LA function was analyzed with STE using Tomtec software. Associations between LA strain (LAS) measurements and primary composite outcome (any adverse cardiovascular event, hospitalisation or reintervention) and secondary outcome (reinterventions) were assessed with Cox regression analysis. Results In total, 98 patients with CAS (mean age: 35.0 ± 11.9y, female: 59.2%) and 121 controls (Age: 43.9 ± 13.8y, female: 55.4%) were included. The majority of patients were in NYHA class I: 97 (99%) at baseline. At baseline, LA conduit strain (LAS-cd) and strain rate (LASR-cd) were significantly lower in patients compared to controls when corrected for age and sex (-18.1 ± 8.7 versus -23.5 ± 9.9%, p = 0.001 and -0.73 ± 0.31 versus -1.02 ± 0.43/s, p < 0.001). During a median follow-up of 6.4 years (5.7-7.1), the primary composite outcome occurred in 48 (39.6%) patients. Kaplan Meier analysis showed that decreased LA conduit strain (<21%) was associated with a higher occurrence of the primary outcome (log-rank: p = 0.008). Depressed LAS-cd and LASR-cd were both associated with the primary composite outcome (univariable HR = 0.64[0.46-0.88], p = 0.005 and HR = 0.68[0.55-0.83], p < 0.001 respectively); adjusted HR (for LAS-cd and LASR-cd, respectively): 0.31(0.09-1.04), p = 0.06 and 0.49(0.26-0.89), p = 0.02. Conclusion Impairment in LA conduit function assessed with STE carries prognostic value in patients with CAS and can be implemented in clinical management.

Prognostic value of left atrial strain in aortic stenosis: A systematic review

“…The included studies reported PALS in patients with AS as summarized in 2. 15,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] LA strain was significantly reduced in AS patients and a PALS <21% was an independent predictor of prognosis. 21 strain (PALS) was independently associated with the primary outcome and an optimal cut-off value of <19% showed the highest diagnostic performance.…”

Prognostic value of left atrial strain in patients with Tetralogy of Fallot

“…LAS analysis was performed in accordance with the previous consensus document by European Society of Cardiology. [13] The de nitions of LA strain, strain rate and volume are summarized in Supplementary table 1. Normative ranges for LA-S [13], LV-GLS [14], LV-SRe [15], and RV-FWLS [16] were extracted from the studies conducted in the same hospital.…”

Atrial Cardiomyopathy in Valvular Heart Disease: From Molecular Biology to Clinical Perspectives

“…A higher atrial pressure induces mechanical stress on the atrial wall, which generates fibroblast activation and atrial fibrosis [ 123 ] ( Figure 2 ). Left atrial dysfunction might appear before atrial enlargement and ventricular damage [ 124 , 125 ]. This could be an initial indicator of atrial cardiomyopathy and might reveal the presence of cardiac injury in aortic stenosis [ 124 , 125 ].…”

“…Left atrial dysfunction might appear before atrial enlargement and ventricular damage [ 124 , 125 ]. This could be an initial indicator of atrial cardiomyopathy and might reveal the presence of cardiac injury in aortic stenosis [ 124 , 125 ]. Atrial remodeling in aortic stenosis can serve as a substrate for atrial fibrillation [ 126 , 127 ] ( Figure 1 ).…”