Prognostic implications of left atrial dilation in aortic regurgitation due to bicuspid aortic valve

Steele C. Butcher, Federico Fortuni, William Kong, E. Mara Vollema, Francesca Prevedello, Rebecca Perry, Arnold Chin Tse Ng, Kian Keong Poh, Ana G. Almeida, Ariana González-Gómez, Mylène Shen, Tiong Cheng Yeo, Miriam Shanks, Bogdan A. Popescu, Laura Galian-Gay, Marcin Fijalkowski, Michael Liang, Edgar Tay, Nina Ajmone Marsan, Joseph B. SelvanayagamFausto J. Pinto, José Zamorano, Philippe Pibarot, Arturo Evangelista, Jeroen J. Bax, Victoria Delgado

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


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/m2, 19.4±3.7 mm/m2, 16.5±3.8 mm/m2 and 20.4±4.5 mm/m2, 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/m2), those with a dilated LAVI (≥35 mL/m2) 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.

Original languageEnglish
Pages (from-to)137-144
Number of pages8
Issue number2
Early online date8 Apr 2021
Publication statusPublished - 1 Jan 2022


  • aortic regurgitation
  • aortic valve insufficiency
  • bicuspid aortic valve
  • echocardiography


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