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Impact of left atrial and diastolic ventricular dysfunction on mortality in patients with aortic stenosis

Nicolas Thellier1, Alexandre Altes1, Jeremy Layec1

  • 1Cardiology Department, Heart Valve Centre, Lille Catholic Hospitals, ETHICS EA 7446, Lille Catholic University, 59462 Lomme Cedex, France.

Archives of Cardiovascular Diseases
|February 4, 2023
PubMed

Insights

Diastolic dysfunction (DD) severity significantly impacts mortality in severe aortic stenosis (AS) patients with preserved ejection fraction. Combining DD grading with atrial strain (PALS) improves risk prediction for these patients.

Area of Science:

  • Cardiology
  • Echocardiography
  • Cardiovascular Imaging

Background:

  • Diastolic dysfunction (DD) is prevalent in severe aortic stenosis (AS) with preserved left ventricular ejection fraction (LVEF).
  • Assessing DD severity and its prognostic implications is crucial in this patient group.

Purpose of the Study:

  • To evaluate the prognostic value of DD grading and left atrial strain on mortality in severe AS patients with preserved LVEF.
  • To determine if combining DD assessment with peak atrial longitudinal strain (PALS) improves mortality prediction.

Main Methods:

  • Retrospective analysis of 387 patients with severe AS and LVEF≥50%.
  • Patients were categorized by DD grade (I, II, III) and PALS (≤14% or >14%).
  • All-cause mortality was the primary endpoint, analyzed using adjusted hazard ratios.

Main Results:

  • Higher DD grades (II and III) were associated with increased mortality risk compared to grade I.
  • Adding PALS to DD grading enhanced predictive performance for mortality.
  • Patients with grade III DD or grade II DD with impaired PALS faced the highest mortality risk.

Conclusions:

  • DD grading and PALS are strong predictors of mortality in severe AS with preserved LVEF.
  • A comprehensive echocardiographic assessment including DD and PALS is vital for risk stratification.
  • Impaired PALS in conjunction with DD grade II or III identifies patients at very high risk.
Abstract

Keywords:
Aortic stenosisDiastolic dysfunctionLeft atrial strainOutcome

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