TY - JOUR
T1 - Prognostic implications of left atrial dilation in aortic regurgitation due to bicuspid aortic valve
AU - Butcher, Steele C.
AU - Fortuni, Federico
AU - Kong, William
AU - Vollema, E. Mara
AU - Prevedello, Francesca
AU - Perry, Rebecca
AU - Ng, Arnold Chin Tse
AU - Poh, Kian Keong
AU - Almeida, Ana G.
AU - González-Gómez, Ariana
AU - Shen, Mylène
AU - Yeo, Tiong Cheng
AU - Shanks, Miriam
AU - Popescu, Bogdan A.
AU - Galian-Gay, Laura
AU - Fijalkowski, Marcin
AU - Liang, Michael
AU - Tay, Edgar
AU - Ajmone Marsan, Nina
AU - Selvanayagam, Joseph B.
AU - Pinto, Fausto J.
AU - Zamorano, José
AU - Pibarot, Philippe
AU - Evangelista, Arturo
AU - Bax, Jeroen J.
AU - Delgado, Victoria
N1 - Publisher Copyright:
© 2021 BMJ Publishing Group. All rights reserved.
PY - 2022/1/1
Y1 - 2022/1/1
N2 - Objective To investigate the prognostic value of left atrial volume index (LAVI) in patients with moderate to severe aortic regurgitation (AR) and bicuspid aortic valve (BAV). Methods 554 individuals (45 (IQR 33-57) years, 80% male) with BAV and moderate or severe AR were selected from an international, multicentre registry. The association between LAVI and the combined endpoint of all-cause mortality or aortic valve surgery was investigated with Cox proportional hazard regression analyses. Results Dilated LAVI was observed in 181 (32.7%) patients. The mean indexed aortic annulus, sinus of Valsalva, sinotubular junction and ascending aorta diameters were 13.0±2.0 mm/m 2, 19.4±3.7 mm/m 2, 16.5±3.8 mm/m 2 and 20.4±4.5 mm/m 2, respectively. After a median follow-up of 23 (4-82) months, 272 patients underwent aortic valve surgery (89%) or died (11%). When compared with patients with normal LAVI (<35 mL/m 2), those with a dilated LAVI (≥35 mL/m 2) had significantly higher rates of aortic valve surgery or mortality (43% and 60% vs 23% and 36%, at 1 and 5 years of follow-up, respectively, p<0.001). Dilated LAVI was independently associated with reduced event-free survival (HR=1.450, 95% CI 1.085 to 1.938, p=0.012) after adjustment for LV ejection fraction, aortic root diameter, LV end-diastolic diameter and LV end-systolic diameter. Conclusions In this large, multicentre registry of patients with BAV and moderate to severe AR, left atrial dilation was independently associated with reduced event-free survival. The role of this parameter for the risk stratification of individuals with significant AR merits further investigation.
AB - Objective To investigate the prognostic value of left atrial volume index (LAVI) in patients with moderate to severe aortic regurgitation (AR) and bicuspid aortic valve (BAV). Methods 554 individuals (45 (IQR 33-57) years, 80% male) with BAV and moderate or severe AR were selected from an international, multicentre registry. The association between LAVI and the combined endpoint of all-cause mortality or aortic valve surgery was investigated with Cox proportional hazard regression analyses. Results Dilated LAVI was observed in 181 (32.7%) patients. The mean indexed aortic annulus, sinus of Valsalva, sinotubular junction and ascending aorta diameters were 13.0±2.0 mm/m 2, 19.4±3.7 mm/m 2, 16.5±3.8 mm/m 2 and 20.4±4.5 mm/m 2, respectively. After a median follow-up of 23 (4-82) months, 272 patients underwent aortic valve surgery (89%) or died (11%). When compared with patients with normal LAVI (<35 mL/m 2), those with a dilated LAVI (≥35 mL/m 2) had significantly higher rates of aortic valve surgery or mortality (43% and 60% vs 23% and 36%, at 1 and 5 years of follow-up, respectively, p<0.001). Dilated LAVI was independently associated with reduced event-free survival (HR=1.450, 95% CI 1.085 to 1.938, p=0.012) after adjustment for LV ejection fraction, aortic root diameter, LV end-diastolic diameter and LV end-systolic diameter. Conclusions In this large, multicentre registry of patients with BAV and moderate to severe AR, left atrial dilation was independently associated with reduced event-free survival. The role of this parameter for the risk stratification of individuals with significant AR merits further investigation.
KW - aortic regurgitation
KW - aortic valve insufficiency
KW - bicuspid aortic valve
KW - echocardiography
UR - http://www.scopus.com/inward/record.url?scp=85104017824&partnerID=8YFLogxK
U2 - 10.1136/heartjnl-2020-318907
DO - 10.1136/heartjnl-2020-318907
M3 - Article
C2 - 33833069
AN - SCOPUS:85104017824
SN - 1355-6037
VL - 108
SP - 137
EP - 144
JO - Heart
JF - Heart
IS - 2
ER -