Incremental prognostic role of left atrial reservoir strain in asymptomatic patients with moderate aortic stenosis

<p>Raw data related to the article</p> <p>Abstract<br> Left atrial (LA) mechanics assessed by two-dimensional speckle tracking echocardiography (2D-STE) have not been extensively<br> studied and clearly characterized in patients with moderate aortic stenosis (AS). Accordingly, we aimed to evaluate<br> the usefulness of LA reservoir strain for risk stratification of asymptomatic patients with moderate AS. This retrospective<br> study included all consecutive asymptomatic patients with moderate AS who underwent transthoracic echocardiography<br> implemented with 2D-STE analysis of LA myocardial strain and strain rate indices at our Institution, between February 2011<br> and September 2019. During the follow-up period, we evaluated the occurrence of any of the following: (1) CV hospitalization;<br> (2) The recourse to AS surgery; (3) Cardiac death or sudden death. A total of 186 patients (mean age 71.9 &plusmn; 12.7 years,<br> 61.8% men) were included in the present study. During a mean follow-up of 2.3 &plusmn; 1.9 years, no patients died and 63 adverse<br> CV events were recorded: 48 patients were hospitalized because of heart failure (28 patients), acute coronary syndrome (10<br> patients), arrhythmias (10 patients) and 15 patients underwent AS surgery. At the multivariate Cox regression analysis, type 2<br> diabetes mellitus (OR 1.87, 95%CI 1.05&ndash;3.34, p = 0.03), NT-proBNP (OR average 1.14, 95%CI 1.02&ndash;1.27, p = 0.02), average<br> E/e&prime; ratio (OR 1.07, 95%CI 1.01&ndash;1.15, p = 0.04) and most of all left atrial positive global strain (LA-GSA+) (OR 0.85, 95%CI<br> 0.81&ndash;0.90, p &lt; 0.0001) were independently associated with the outcome. LA-GSA+ (optimal cut-off &le; 19%, AUC = 0.94,<br> 87% sensitivity, 99% specificity, positive predictive value 99%, negative predictive value 88%) showed the highest diagnostic<br> performance. An impaired LA reservoir strain can contribute to identify a subset of asymptomatic patients with moderate<br> AS at higher risk, who may benefit from closer echocardiographic follow-up and/or early surgery.</p>