Aortic valve stenosis (AS) is the most common primary valvular heart disease leading to surgical or percutaneous aortic valve replacement (AVR) in Europe and its prevalence keeps growing. While other risk factors in severe AS are well documented, little is known about the prognostic value of left atrial (LA) function in AS. Our aim is to clarify the relationship between LA function measured at severe AS diagnosis (evaluated by means of volumetric assessment) and all-cause mortality during follow-up. We retrospectively evaluated patients diagnosed with severe AS for the first time at our echocardiography laboratory. We evaluated LA reservoir, conduit and pump function by measuring LA volumes at different timings of cardiac cycle. Treatment strategy was decided according to heart team consensus and patient decision. We divided patients into groups according to terciles of LA reservoir, conduit and pump function. Primary outcome was defined by the occurrence of all-cause mortality during follow-up. A total of 408 patients were included in the analysis, with a median follow-up time of 45 months (interquartile range 54 months). 57.9% of patients underwent AVR and 44.9% of patients registered the primary outcome during follow-up. Left atrial emptying fraction (LAEF) was the best LA functional parameter and the best overall parameter in discriminating primary outcome (AUC 0.845, 95%CI 0.81–0.88, P < 0.001). After adjustment for clinical, demographic and echocardiographic variables, cumulative survival of patients with LAEF < 37% and LAEF 37 to 53% relative to patients with LAEF ≥54% remained significantly lower (HR 13.91, 95%CI 6.20–31.19, P < 0.001 and HR 3.40, 95%CI 1.57–7.37, P = 0.002, respectively). After adjustment for AVR, excess risk of LAEF < 37% and LAEF 37 to 53% relative to LAEF ≥54% remained significant (HR 11.71, 95%CI 5.20–26.40, P < 0.001 and HR 3.59, 95%CI 1.65–7.78, P = 0.001, respectively). In patients with a first diagnosis of severe AS, LA function, evaluated by means of volumetric assessment, is an independent predictor of all-cause mortality and a more potent predictor of death compared to classical severity parameters. These data can be useful to identify high-risk patients who might benefit of AVR.

中文翻译：

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窦性心律重度主动脉瓣狭窄患者左心房功能评估及死亡率

主动脉瓣狭窄 (AS) 是欧洲最常见的原发性心脏瓣膜病，导致手术或经皮主动脉瓣置换术 (AVR)，其患病率不断增加。虽然严重 AS 的其他风险因素有据可查，但对 AS 中左心房 (LA) 功能的预后价值知之甚少。我们的目的是阐明在严重 AS 诊断时测量的 LA 功能（通过容积评估评估）与随访期间全因死亡率之间的关系。我们在超声心动图实验室首次对诊断为严重 AS 的患者进行了回顾性评估。我们通过在心动周期的不同时间测量 LA 容量来评估 LA 水库、导管和泵功能。根据心脏团队的共识和患者的决定决定治疗策略。我们根据 LA 水库、导管和泵功能的三分位数将患者分组。主要结局由随访期间全因死亡率的发生率定义。共有 408 名患者被纳入分析，中位随访时间为 45 个月（四分位距为 54 个月）。57.9% 的患者接受了 AVR，44.9% 的患者在随访期间记录了主要结果。左心房排空分数 (LAEF) 是区分主要结局的最佳 LA 功能参数和最佳总体参数（AUC 0.845，95%CI 0.81–0.88，P < 0.001）。在调整临床、人口统计学和超声心动图变量后，LAEF < 37% 和 LAEF 37% 至 53% 的患者相对于 LAEF ≥ 54% 的患者的累积生存率仍然显着较低（HR 13.91，95%CI 6.20-31.19，P < 0 . 001 和 HR 3.40，95% CI 1.57–7.37，分别为 P = 0.002）。调整 AVR 后，LAEF < 37% 和 LAEF 37% 至 53% 相对于 LAEF ≥ 54% 的超额风险仍然显着（HR 11.71，95%CI 5.20-26.40，P < 0.001 和 HR 3.59，95%CI 1.65-7。 , P = 0.001, 分别）。在首次诊断为严重 AS 的患者中，通过容积评估评估的 LA 功能是全因死亡率的独立预测因子，并且与经典的严重程度参数相比，它是更有效的死亡预测因子。这些数据可用于识别可能受益于 AVR 的高风险患者。在首次诊断为严重 AS 的患者中，通过容积评估评估的 LA 功能是全因死亡率的独立预测因子，并且与经典的严重程度参数相比，它是更有效的死亡预测因子。这些数据可用于识别可能受益于 AVR 的高风险患者。在首次诊断为严重 AS 的患者中，通过容积评估评估的 LA 功能是全因死亡率的独立预测因子，并且与经典的严重程度参数相比，它是更有效的死亡预测因子。这些数据可用于识别可能受益于 AVR 的高风险患者。