Echocardiographic assessment of left atrial structure and function in severe aortic stenosis with preserved vs....

This study investigated the changes in left atrial (LA) structure and function in patients with severe aortic stenosis (AS) by comparing those with preserved left ventricular ejection fraction (LVEF) to those with reduced LVEF.

Patients with severe AS were classified into two groups: preserved LVEF (≥ 50%) and reduced LVEF (< 50%). Healthy controls were also enrolled. Transthoracic echocardiography and two-dimensional speckle-tracking echocardiography (2D-STE) were employed to measure LA structural parameters and evaluate LA function. Restricted cubic splines (RCS) analyses were used to explore the nonlinear relationship between LVEF and LA parameters.

Patients with an LVEF < 50% had larger LA volumes [LA maximal volume (LAVmax), LA minimal volume (LAVmin), LA pre-systolic volume (LAVpre), and LA volume index (LAVI)] and higher left atrioventricular coupling index (LACI) and LA stiffness index (LASI) than those with an LVEF ≥ 50% (P < 0.05). LA functional parameters [including LA total emptying fraction (LATEF), LA active emptying fraction (LAVaEF), LA passive emptying fraction (LAVpEF), LA expansion index (LAEI)] and the absolute values of LA strain were significantly impaired in severe AS patients with an LVEF < 50% compared with those with an LVEF ≥ 50% (P < 0.05). Furthermore, the LVEF inflection points for trend changes in LA structure and function were approximately 46% and 59%, respectively.

In patients with severe AS, LA structural and functional impairments are evident even when LVEF ≥ 50%, and become more pronounced in those with an LVEF < 50%.