Usefulness of atrial function for risk stratification in asymptomatic severe aortic stenosis

Todaro, Maria Chiara; Carerj, Scipione; Khandheria, Bijoy K.; Cusmà-Piccione, Maurizio; Carrubba, Salvatore La; Antonini‐Canterin, Francesco; Pugliatti, Pietro; Bello, Vitantonio Di; Oreto, Giuseppe; Bella, Gianluca Di; Zito, Concetta

doi:10.1016/j.jjcc.2015.04.010

Cited by 37 publications

(44 citation statements)

References 45 publications

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“…Todaro et al, found that an increased LASt is suggested to be an index of atrial‐ventricular coupling index and potentially able to predict a worse prognostic burden, even in still asymptomatic patients. Indeed, they demonstrated that the increased LASt significantly correlated with a more severe aortic stenosis, a low‐flow state, a higher valvulo‐arterial impedance, increased filling pressure, lower left ventricular longitudinal function, and decreased untwisting forces of the ventricle.…”

Section: Discussionmentioning

confidence: 99%

Association between left atrial stiffness and aortic plaque thickness in hypertensive patients with stroke

et al. 2018

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Objective Our aim was to investigate the relation between left atrial stiffness (LASt) and thoracic aortic plaque thickness in hypertensive patients with stroke. Method A total of 97 hypertensive patients were recruited (age: 59.2 ± 7.5 years), including 56 consecutive patients with undefined stroke and 41 age‐matched hypertensive patients without stroke. Left atrial strain and stiffness were measured using speckle tracking echo. Thoracic aortic plaque detection and evaluation was performed using transesophageal echocardiography. Results Hypertensive patients with stroke, when compared with those without stroke, had a significantly higher LASt value (P < .001). The percentage of plaque 1–4 mm thickness were comparable in both groups (23.2% vs 21.9%; P > .05). While the percentage of plaque ≥4 mm thickness was much higher in hypertensive patients with stroke (71.4% vs 4.9%; P < .001). LASt was considerably increased in hypertensive group with paroxysmal atrial fibrillation (PAF) when compared to hypertensive group without PAF (P < .01). A significant positive correlation was found between the LASt and plaque thickness (P < .001). Multivariate analysis showed that LASt was the strongest independent predictor for ≥4 mm aortic plaque thickness (Hazard ratio = 6.153; P < .001). With receiver operating characteristic (ROC) curve analysis, LASt > 0.63 was the best cutoff value in predicting aortic plaque thickness ≥ 4 mm. Conclusion Left atrial stiffness was significantly associated with aortic plaque thickness ≥ 4 mm, in hypertensive patients with stroke. These finding prevailed the importance of LASt in risk stratification of hypertension.

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Section: Discussionmentioning

confidence: 99%

Association between left atrial stiffness and aortic plaque thickness in hypertensive patients with stroke

et al. 2018

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“…Furthermore, the new echocardiographic techniques, like 2D speckle tracking echocardiography, have been shown to have an important role in the prognostic evaluation of patients with AS and this is true for both LV and LA function [24].…”

Section: Discussionmentioning

confidence: 99%

Exercise stress echocardiography with tissue Doppler imaging in risk stratification of mild to moderate aortic stenosis

Sonaglioni

Lombardo

Baravelli

et al. 2015

Int J Cardiovasc Imaging

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“…However, it seems that LA function is impaired before LA enlargement occurs in several conditions including aortic stenosis . Using ultrasound, LA function could be assessed by standard two‐dimensional echocardiography (LA volume change during the cardiac cycle), by Doppler tissue imaging, and by advanced techniques such as two‐dimensional strain . Altered LA function is associated with a poor prognosis in a number of conditions .…”

Section: Introductionmentioning

confidence: 99%

“…Using ultrasound, LA function could be assessed by standard two‐dimensional echocardiography (LA volume change during the cardiac cycle), by Doppler tissue imaging, and by advanced techniques such as two‐dimensional strain . Altered LA function is associated with a poor prognosis in a number of conditions . In some studies, LA distensibility was used as a diagnostic marker of left ventricular (LV) diastolic dysfunction as well as a prognostic indicator, whereas in other studies LA strain was used to assess the same endpoints .…”

Section: Introductionmentioning

confidence: 99%

Left atrial strain and distensibility in relation to left ventricular dysfunction and prognosis in aortic stenosis

et al. 2019

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Objective To test the relationship between left atrial (LA) distensibility (LAD), LA strain (LAS), and left ventricular (LV) dysfunction and prognosis in aortic stenosis (AS). Methods Transthoracic Doppler echocardiography was performed prospectively in 102 consecutive patients with AS (77 with severe, 25 with moderate, mean age 77 years). LA volume was calculated by the area‐length method in apical four‐ and two‐chamber views, immediately before mitral valve opening (Volmax) and at mitral valve closure (Volmin). LAD was defined as (Volmax – Volmin) × 100%/Volmin. LAS (mean of maximal strain from the 4–2 chamber views) was conducted using a dedicated software package. The endpoint was hospitalization for heart failure and death from any cause. Results Left atrial strain, LAD, and LA vol/m² were significantly correlated with LV diastolic parameters, and PASP (all, P < 0.05). However, LAD and LAS but not LA vol/m² were significantly correlated with Charlson score, LV global longitudinal strain, and to transaortic mean gradient (all, P < 0.05). At a median follow‐up of 25 months, 53 patients had an event. LAS, LAD, LA vol/m², and Charlson index were associated with events (all, P < 0.05). In multivariate analysis, LAD, LAS, and Charlson index (all, P < 0.01) remained independently associated with events. Using a ROC curve analysis, LAD ≤ 69% and LAS ≤ 17% were the best cutoffs associated with an event. Conclusion In patients with moderate to severe AS, LAD and LAS are associated with LV dysfunction, AS severity, and are independently linked to events.

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Usefulness of atrial function for risk stratification in asymptomatic severe aortic stenosis

Cited by 37 publications

References 45 publications

Association between left atrial stiffness and aortic plaque thickness in hypertensive patients with stroke

Association between left atrial stiffness and aortic plaque thickness in hypertensive patients with stroke

Exercise stress echocardiography with tissue Doppler imaging in risk stratification of mild to moderate aortic stenosis

Left atrial strain and distensibility in relation to left ventricular dysfunction and prognosis in aortic stenosis

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