Relation of Left Atrial Size, Cardiac Morphology, and Clinical Outcome in Asymptomatic Aortic Stenosis

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Left atrial (LA) dilatation in asymptomatic severe aortic stenosis (AS) may be an indicator of advanced disease. The aim was to investigate the association between LA volume index (LAVi) and left ventricular (LV) morphology assessed with cardiac magnetic resonance imaging (cMRI), and to assess the association with cardiac events in asymptomatic AS. Ninety-two asymptomatic patients with aortic valve area (AVA) <1 cm² and aortic peak jet velocity > 3.5 m/s, and ejection fraction ≥ 50% were prospectively enrolled. Patients were divided according to echocardiographic-derived LAVi < 35 ml/m². Patients underwent echocardiography, cMRI, exercise test, and patients were followed for the composite endpoint of death, readmission or aortic valve replacement. AVA index was similar (0.45 ± 0.08 cm² /m² vs. 0.45 ± 0.09 cm², p=0.85) in patients with a dilated and normal LA. On cMRI patients with dilated LA were characterized by higher LV mass index (73 ± 17 g/m² vs. 66 ± 16 g/m² , p=0.03), increased right ventricle (70 ± 14 ml/m² vs. 63 ± 12 ml/m², p=0.01) and LV end-diastolic volume index (84 ± 18 ml/m² vs. 77 ± 16 ml/m², p=0.05), and higher brain natriuretic peptide (BNP). No difference in late enhancement was seen between groups. During follow-up 28 events were recorded 20 in patients with LA dilatation compared to 8 in patients with a normal LA (adjusted hazard ratio 2.77, 95% confidence interval 1.19-6.46, p=0.02), also BNP > 125 pg/ml was associated with adverse outcome (adjusted hazard ratio of 3.63 (95% CI interval 1.28-10.32, p=0.02). LA dilatation is associated with adverse LV remodeling and provides important prognostic information in severe asymptomatic AS.
LanguageEnglish
JournalThe American Journal of Cardiology
Volume120
Issue number10
Pages (from-to)1877-1883
ISSN0002-9149
DOIs
Publication statusPublished - 2017