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Prognostic value of left atrial stiffness index in adults with repaired coarctation of aorta

Omar Abozied1, William R Miranda1, Maan Jokhadar1

  • 1Department of Cardiovascular Medicine, Mayo Clinic Rochester, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA.

European Heart Journal. Cardiovascular Imaging
|December 30, 2025
PubMed

Insights

The left atrial (LA) stiffness index effectively predicts worse outcomes in adults with coarctation of the aorta (COA). This echocardiographic measure identifies patients at higher risk for heart failure hospitalization and mortality.

Area of Science:

  • Cardiology
  • Echocardiography
  • Medical Prognostics

Background:

  • Coarctation of the aorta (COA) is a congenital heart defect impacting aortic blood flow.
  • Adults with repaired COA often experience long-term cardiovascular complications.
  • Left atrial (LA) stiffness is a known prognostic marker in heart failure with preserved ejection fraction.

Purpose of the Study:

  • To investigate the utility of the LA stiffness index in predicting disease severity and clinical outcomes in adults with repaired COA.
  • To test the hypothesis that high LA stiffness index correlates with worse indices of disease severity, including peak VO2, NT-proBNP, and RV-PA coupling.
  • To assess the association of LA stiffness index with heart failure hospitalization and all-cause mortality in this population.

Main Methods:

  • The study included 729 adults with repaired COA.
  • LA stiffness index was calculated from baseline echocardiograms as the ratio of septal E/e' to LA reservoir strain.
  • Patients were stratified into high (>0.28) and low (≤0.28) LA stiffness index groups based on the median value.

Main Results:

  • LA stiffness index demonstrated significant correlations with RV-PA coupling (r = -0.56), NT-proBNP (r = 0.62), and predicted peak VO2 (r = -0.51).
  • A high LA stiffness index was significantly associated with increased risk of heart failure hospitalization (adjusted HR 3.17) and all-cause mortality (adjusted HR 2.81).
  • The LA stiffness index showed superior performance in predicting 5-year risks of heart failure hospitalization (AUC 0.803) and all-cause mortality (AUC 0.786) compared to conventional echocardiographic measures.

Conclusions:

  • The LA stiffness index is a valuable prognostic tool in adults with repaired COA.
  • This index can help identify patients at higher risk for adverse cardiovascular events.
  • LA stiffness index may guide treatment decisions and monitor therapeutic responses in COA patients.
Abstract

Keywords:
heart failureleft atrial functionmortalityprognostication

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