Abstract
Left atrial (LA) mechanics assessed by two-dimensional speckle tracking echocardiography (2D-STE) have not been extensively studied and clearly characterized in patients with moderate aortic stenosis (AS). Accordingly, we aimed to evaluate the usefulness of LA reservoir strain for risk stratification of asymptomatic patients with moderate AS. This retrospective study included all consecutive asymptomatic patients with moderate AS who underwent transthoracic echocardiography implemented with 2D-STE analysis of LA myocardial strain and strain rate indices at our Institution, between February 2011 and September 2019. During the follow-up period, we evaluated the occurrence of any of the following: (1) CV hospitalization; (2) The recourse to AS surgery; (3) Cardiac death or sudden death. A total of 186 patients (mean age 71.9 ± 12.7 years, 61.8% men) were included in the present study. During a mean follow-up of 2.3 ± 1.9 years, no patients died and 63 adverse CV events were recorded: 48 patients were hospitalized because of heart failure (28 patients), acute coronary syndrome (10 patients), arrhythmias (10 patients) and 15 patients underwent AS surgery. At the multivariate Cox regression analysis, type 2 diabetes mellitus (OR 1.87, 95%CI 1.05–3.34, p = 0.03), NT-proBNP (OR average 1.14, 95%CI 1.02–1.27, p = 0.02), average E/e′ ratio (OR 1.07, 95%CI 1.01–1.15, p = 0.04) and most of all left atrial positive global strain (LA-GSA+) (OR 0.85, 95%CI 0.81–0.90, p < 0.0001) were independently associated with the outcome. LA-GSA+ (optimal cut-off ≤ 19%, AUC = 0.94, 87% sensitivity, 99% specificity, positive predictive value 99%, negative predictive value 88%) showed the highest diagnostic performance. An impaired LA reservoir strain can contribute to identify a subset of asymptomatic patients with moderate AS at higher risk, who may benefit from closer echocardiographic follow-up and/or early surgery.
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Abbreviations
- 2D:
-
Two-dimensional
- ACS:
-
Acute coronary syndrome
- AF:
-
Atrial fibrillation
- AS:
-
Aortic stenosis
- AUC:
-
Area under the curve
- AVA:
-
Aortic valve area
- BP:
-
Blood pressure
- BSA:
-
Body surface area
- CAD:
-
Coronary artery disease
- CHF:
-
Congestive heart failure
- CI:
-
Confidence interval
- CT:
-
Computed tomography
- CV:
-
Cardiovascular
- EaI:
-
Arterial elastance index
- ECG:
-
Electrocardiogram
- eGFR:
-
Estimated glomerular filtration rate
- ESP:
-
End-systolic pressure
- GSA+:
-
Positive global atrial strain
- GSA−:
-
Negative global atrial strain
- GSR+:
-
Positive global strain rate
- GSRE:
-
Global early-diastolic strain rate
- GSRL:
-
Global late-diastolic strain rate
- HR:
-
Heart rate
- ICC:
-
Intraclass correlation coefficient
- LDL:
-
Low-density lipoprotein
- LA:
-
Left atrial
- LAVi:
-
Left atrial volume index
- LV:
-
Left ventricular
- LVEDVi:
-
Left ventricular end-diastolic volume index
- LVEF:
-
Left ventricular ejection fraction
- LVFP:
-
Left ventricular filling pressure
- LVMi:
-
Left ventricular mass index
- LVOT:
-
Left ventricular outflow tract
- MR:
-
Mitral regurgitation
- MTPG:
-
Mean transaortic pressure gradient
- NT-proBNP:
-
N-terminal pro–B-type natriuretic peptide
- PH:
-
Pulmonary hypertension
- RVIT:
-
Right ventricular inflow tract
- ROC:
-
Receiver operating characteristics
- SPAP:
-
Systolic pulmonary artery pressure
- SR:
-
Strain rate
- STE:
-
Speckle tracking echocardiography
- SVi:
-
Stroke volume index
- TAPSE:
-
Tricuspid annular plane systolic excursion
- TAVR:
-
Transcatheter aortic valve replacement
- TRV:
-
Tricuspid regurgitation velocity
- TTE:
-
Transthoracic echocardiography
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Acknowledgements
This work has been supported by Italian Ministry of Health Ricerca Corrente—IRCCS MultiMedica.
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AS: Conceptualization; Data curation; Investigation; Methodology; Software; Visualization; Writing—original draft. GLN: Conceptualization; Data curation; Methodology; Writing—review & editing. ER: Conceptualization; Data curation; Methodology; Writing—review & editing. ML: Conceptualization; Supervision; Validation; Writing—review & editing.
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All procedures performed in the present study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Sonaglioni, A., Nicolosi, G.L., Rigamonti, E. et al. Incremental prognostic role of left atrial reservoir strain in asymptomatic patients with moderate aortic stenosis. Int J Cardiovasc Imaging 37, 1913–1925 (2021). https://doi.org/10.1007/s10554-021-02175-6
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DOI: https://doi.org/10.1007/s10554-021-02175-6