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
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/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.
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/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.
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
AN - SCOPUS:85104017824
SN - 1355-6037
VL - 108
SP - 137
EP - 144
JO - Heart
JF - Heart
IS - 2
ER -