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Left Atrial Volume as Predictor of Valve Replacement and Cardiovascular Events in Patients with Asymptomatic Mild to Moderate Aortic Stenosis
Author(s) -
Dalsgaard Morten,
Egstrup Kenneth,
Wachtell Kristian,
Cramariuc Dana,
Kjaergaard Jesper,
Gerdts Eva,
Hassager Christian
Publication year - 2013
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.12184
Subject(s) - cardiology , medicine , asymptomatic , aortic valve replacement , stenosis , aortic valve stenosis , heart failure , ejection fraction , left ventricular hypertrophy , aortic valve , blood pressure
Background Left atrial ( LA ) size is known to increase with chronically increased left ventricular ( LV ) filling pressure. We hypothesized that LA volume was predictive of aortic valve replacement ( AVR ) and cardiovascular events in a large cohort of patients with asymptomatic mild to moderate aortic valve stenosis. Methods Transthoracic echocardiography was performed in 1,758 patients in the Simvastatin and Ezetemibe in Aortic Stenosis study. LA volume was measured in the apical four‐chamber view in 1,503 patients (85%). The relation of LA volume to AVR or a combined endpoint of cardiovascular events ( AVR , congestive heart failure due to aortic stenosis or death from cardiovascular causes) was evaluated. Results AVR was performed in 415 (28%) patients, whereas 505 (34%) reached the combined endpoint. A significant but weak association of increased LA volume and risk of the combined endpoint was found (log‐rank test: P = 0.02), but this relation did not reach any significance in a multivariate model adjusting for age, gender, aortic valve area index, LV ejection fraction, LV hypertrophy, hypertension, and mitral regurgitation. LA volume was not predictive of AVR (log‐rank test: P = 0.3). Conclusion In asymptomatic patients with mild to moderate Aortic valve stenosis ( AS ), LA volume was not predictive of the combined endpoint of Aortic valve replacement, development of heart failure or cardiac death. AVA and presence of LV hypertrophy were the only predictors of events in multivariate analysis.