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Prognostic value of diastolic function parameters in significant aortic regurgitation: the role of the left atrial strain

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Abstract

Background

The management of patients with asymptomatic significant aortic regurgitation (sAR) is often challenging and appropriate timing of aortic valve surgery remains controversial. Prognostic value of diastolic parameters has been demonstrated in several cardiac diseases. The aim of this study was to analyze the prognostic significance of the diastolic function evaluated by echocardiography, in asymptomatic patients with sAR.

Methods

A total of 126 patients with asymptomatic sAR evaluated in the Heart Valve Clinic were retrospective included. Conventional echocardiographic systolic and diastolic function parameters were assessed. Left atrial (LA) auto-strain analysis was performed in a sub-group of 57 patients. A combined end-point of hospital admission due to heart failure, cardiovascular mortality, or aortic valve surgery was defined.

Results

During a median follow-up of 34.1 (interquartile range 16.5–48.1) months, 25 (19.8%) patients reached the combined end-point.

Univariate analysis showed that LV volumes, LV ejection fraction (LVEF), LV-GLS, E wave, E/e’ ratio, LA volume and LA reservoir strain (LASr) were significant predictors of events. Multivariate analysis that tested all classical echocardiographic variables statistically significant in the univariate model showed that LVEDV (HR = 1.02; 95% CI 1.01–1.03; p < 0.001) and E/e’ ratio (HR = 1.12; 95% CI 1.03–123; p = 0.01) were significant predictors of events. Kaplan–Meier curve, stratified by median value of LASr, showed that lower LASr values (less than median of 34%) were associated with higher rates of events (p = 0.013).

Conclusion

In this population of asymptomatic patients with sAR and normal LV systolic function, baseline diastolic parameters were prognostic markers of cardiovascular events; among them, LASr played a significant predictor role.

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Abbreviations

AUC:

Area under the curve

LA:

Left atrial

LASct:

Left atrial strain contractile

LASr:

Left atrial strain reservoir

LAScd:

Left atrial strain conduit

LV:

Left ventricle

LVEF:

Left ventricle ejection fraction

LV-GLS:

Left ventricular global longitudinal strain

sAR:

Significant aortic regurgitation

SD:

Standard deviation

SPAP:

Systolic pulmonary artery pressure

TTE:

Transthoracic echocardiography

TR:

Tricuspid regurgitation

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Authors and Affiliations

  1. Department of Cardiology, Ramón y Cajal University Hospital, CIBER CV, Ctra, Colmenar Km 9,100, 28034, Madrid, Spain

    Ana García Martín, María Abellás Sequeiros, Ariana González González Gómez, Juan Manuel Monteagudo Ruiz, Rocío Hinojar Baydés, Jose Luis Moya Mur, José Luis Zamorano & Covadonga Fernández-Golfín

  2. Department of Cardiology, University Hospital, Salamanca, Spain

    Luis Miguel Rincón Díaz

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  1. Ana García Martín
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  2. María Abellás Sequeiros
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  3. Ariana González González Gómez
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  9. Covadonga Fernández-Golfín
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Correspondence to Ana García Martín.

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García Martín, A., Abellás Sequeiros, M., González Gómez, A.G. et al. Prognostic value of diastolic function parameters in significant aortic regurgitation: the role of the left atrial strain. J Echocardiogr 20, 216–223 (2022). https://doi.org/10.1007/s12574-022-00577-6

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  • DOI: https://doi.org/10.1007/s12574-022-00577-6

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