Significance of echocardiographic left atrial enlargement in aortic stenosis

This study investigated the significance of echocardiographic left atrial enlargement as measured by the left atrial dimension corrected for body surface area in 24 patients with pure aortic stenosis established by cardiac catheterization. Echocardiographic evidence of left atrial enlargement occurred in 11 of 15 patients (73%) with an aortic valve area below 0.8 cm2 and in none of nine patients (0%) with an aortic valve area above 0.8 cm2, p less than 0.0025. All 11 patients (100%) with an enlarged left atrial dimension had an increased diastolic left ventricular dimension, whereas 1 of 13 patients (8%) with a normal left atrial dimension had an increased diastolic left ventricular dimension, p less than 0.00001. The 11 patients (100%) with an enlarged left atrial dimension had increased posterior left ventricular wall thickness, whereas 2 of 13 patients (13%) with a normal left atrial dimension had increased posterior left ventricular wall thickness (p less than 0.0005). These data lead one to conclude that in patients with pure aortic stenosis, echocardiographic evidence of left atrial enlargement as measured by an increased left atrial dimension corrected for body surface area should lead one to suspect severe aortic stenosis.