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Published on: July 20, 2022
Sex-Specific Left Atrial Strain Thresholds Predict Outcomes in Aortic Stenosis
Paolo Springhetti1, Giovanni Benfari2, Michele Tomaselli1
1Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy.
Summary
Sex-specific thresholds for left atrial reservoir strain (LARS) better predict adverse outcomes in aortic stenosis (AS) than universal cut-offs or left atrial volume index (LAVi). This enhances risk stratification for personalized patient management.
Area of Science:
- Cardiology
- Echocardiography
- Cardiac Imaging
Background:
- Left atrial (LA) remodeling is a key indicator of cardiac damage in aortic stenosis (AS).
- Left atrial volume index (LAVi) reflects chronic pressure overload, while left atrial reservoir strain (LARS) detects early LA dysfunction via speckle-tracking echocardiography.
Purpose of the Study:
- To determine the prognostic value of LAVi and LARS in AS patients.
- To establish optimal cut-offs for LAVi and LARS associated with adverse outcomes.
- To assess if sex-specific thresholds improve risk stratification for AS.
Main Methods:
- Retrospective analysis of 552 moderate AS patients in sinus rhythm.
- Composite endpoint: all-cause mortality or heart failure hospitalization (HHF).
- External validation in 192 AS patients; multivariable Cox regression used.
Main Results:
- Lower LARS, not LAVi, independently predicted adverse outcomes (mortality/HHF) after multivariable adjustment.
- Optimal sex-specific LARS thresholds: <13% for women, <19% for men.
- Sex-specific LARS thresholds showed independent prognostic significance in both sexes, validated externally.
Conclusions:
- Sex-specific LARS thresholds offer superior independent prediction of mortality and HHF in AS compared to LAVi or universal cut-offs.
- Integrating LA strain assessment into AS risk stratification can improve prognostic accuracy.
- Personalized management strategies in AS may benefit from sex-specific LA strain analysis.
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