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Prognostic value of left atrial strain in significant aortic valve disease: a systematic review and meta-analysis

Na Chen1,2, Wenhui Gu1, Jun Wu1

  • 1Department of Echocardiography, The Second Affiliated Hospital of Dalian Medical University, Dalian, China.

Frontiers in Cardiovascular Medicine
|October 2, 2025
PubMed

Insights

Left atrial strain (PALS) is a valuable independent predictor of adverse cardiovascular events in patients with significant aortic valve disease. Lower PALS indicates a higher risk of adverse outcomes, highlighting its prognostic importance.

Area of Science:

  • Cardiology
  • Echocardiography
  • Cardiovascular Medicine

Background:

  • Aortic valve disease (AVD) research has historically focused on the left ventricle.
  • Emerging evidence indicates left atrial strain (LAS) also holds prognostic significance in AVD.

Purpose of the Study:

  • To systematically evaluate the prognostic value of left atrial strain in significant aortic valve disease.
  • To assess the predictive capability of peak left atrial longitudinal strain (PALS) for adverse cardiovascular events.

Main Methods:

  • A comprehensive systematic review and meta-analysis was conducted.
  • Searched multiple databases for studies on aortic stenosis (AS) or aortic regurgitation (AR) using PALS.
  • Primary endpoint included mortality, heart failure hospitalization, aortic valve replacement, pulmonary hypertension, and new-onset atrial fibrillation.

Main Results:

  • 25 studies involving 7,195 patients were analyzed.
  • Lower PALS was significantly associated with a higher incidence of primary endpoint events (SMD = -1.03, p < 0.05).
  • Each unit increase in PALS reduced the risk of primary endpoint events by 7% (HR = 0.93, p < 0.001).

Conclusions:

  • Peak left atrial longitudinal strain (PALS) is an independent predictor of adverse cardiovascular events in significant aortic valve disease.
  • PALS demonstrates significant prognostic value for patients with aortic stenosis and aortic regurgitation.
Abstract

Keywords:
aortic regurgitationaortic stenosisleft atrial strainmeta-analysispeak left atrial longitudinal strainsystematic review

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