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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Severe Aortic Stenosis Is Associated With Left Atrial Prothrombotic Flow That Persists Despite Valve Replacement

Marco Spartera1,2, Antonio Stracquadanio1,2, Ludovica Bognoni1,2

  • 1Division of Cardiovascular Medicine, Radcliffe Department of Medicine University of Oxford United Kingdom.

Journal of the American Heart Association
|April 9, 2026
PubMed

Insights

Severe aortic stenosis (AS) causes prothrombotic left atrial (LA) flow changes. These adverse flow characteristics persist after aortic valve replacement (AVR), indicating a potential stroke risk factor.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Hemodynamics

Background:

  • Severe aortic stenosis (AS) is linked to ischemic stroke, independent of other risk factors.
  • A significant stroke rate persists even after aortic valve replacement (AVR).
  • The underlying pathophysiology of stroke risk in AS patients requires further elucidation.

Purpose of the Study:

  • To investigate the hypothesis that severe AS is associated with prothrombotic left atrial (LA) flow changes.
  • To determine if these LA flow changes normalize after AVR.

Main Methods:

  • Cardiac magnetic resonance imaging (CMR) was used to assess 77 participants (40 severe AS, 37 controls) without atrial fibrillation.
  • Baseline CMR was performed on all participants.
  • 23 of 40 AS patients underwent AVR and repeat CMR approximately 6 months post-surgery.

Main Results:

  • Severe AS patients showed higher LV mass, smaller LV volumes, and reduced global longitudinal strain compared to controls.
  • Despite normal LA volume and emptying fraction, severe AS was associated with lower LA peak flow velocity and vorticity.
  • AVR reduced LV hypertrophy, but LA flow velocity and vorticity remained significantly lower than controls post-surgery.

Conclusions:

  • Severe aortic stenosis is associated with adverse, prothrombotic left atrial flow dynamics.
  • These abnormal LA flow characteristics persist after successful aortic valve replacement.
  • The persistent LA flow abnormalities may contribute to the ongoing stroke risk in AS patients post-AVR.
Abstract

Keywords:
4‐dimensional flow CMRaortic stenosisleft atrial myopathystroke risk

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