Abstract 10996: Association of Left Atrial Booster-Pump Function With Heart Failure Symptoms in Patients With Severe Aortic Stenosis and Preserved Ejection Fraction
Background: According to the current guidelines for patients with severe aortic stenosis (AS), aortic valve replacement (AVR) is recommended when patients become symptomatic or when left ventricular (LV) ejection fraction (EF) has decreased <50% in asymptomatic patients. Currently, the management of asymptomatic patients with severe AS and preserved EF thus remains controversial. It was recently reported that resting left atrial (LA) functions was related to exercise performance in patients with heart failure. The aim of this study was thus to assess the association of the development of heart failure symptoms with LA function in patients with severe AS to make use for determining surgical indication.
Methods: We studied 34 patients with severe AS referred for AVR. All patients were in sinus rhythm, and their mean age was 76±8 years and EF was 66±8% (all≥50%). In total, 18 patients were characterized as symptomatic status according to the NYHA functional classification, and the remaining 16 were classified as asymptomatic status. LA reservoir (SR-LAs), conduit (SR-LAe), and booster-pump (SR-LAa) function were determined as the averaged global LA speckle-tracking longitudinal strain rate from apical 4- and 2-chamber views.
Results: AS severity such as indexed aortic valve area and mean pressure gradient were similar between 2 groups. Symptomatic status was associated with systolic blood pressure, brain natriuretic peptide, LV end-systolic volume index, LVEF, LA volume index, SR-LAs, SR-LAe, and SR-LAa. An important finding of multivariate analysis revealed that SR-LAa was the only independent determinant of symptomatic status in patients with severe AS (β=0.0017, p=0.005).
Conclusions: In patients with severe AS, SR-LAa was associated with the development of heart failure symptoms irrespective of AS severity. Characterization of LA booster-pump function may be useful to improve risk stratification and clinical decision making in patients with AS.
- © 2013 by American Heart Association, Inc.