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Left atrial geometric and functional remodeling parameters by cardiac magnetic resonance imaging and outcome prediction in patients with severe aortic stenosis

Carmen Cionca123, Alexandru Zlibut14, Rares-Ilie Orzan14, Bianca Olivia Cojan-Minzat145, Dalma Horvat14, Ioana Danuta Muresan14, Eva Kiss14, Diana Gonciar14, Dan Dirzu6, Serban Seicean1, Lucia Agoston-Coldea134, Teodora Mocan12
DOI: 10.33963/KP.a2022.0265
·
Pubmed: 36446068
Affiliations
  1. Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
  2. Physiology Department, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
  3. Department of Radiology, Affidea Hiperdia Diagnostic Imaging Center, Cluj-Napoca, Romania
  4. 2nd Department of Internal Medicine, Emergency County Hospital, Cluj-Napoca, Romania
  5. Department of Family Medicine, Cluj-Napoca, Romania
  6. Emergency County Hospital, Cluj-Napoca, Romania

open access

Online first
Original article
Published online: 2022-11-28

Abstract

BACKGROUND: Emerging studies are beginning to shape the role of afflicted left atrium’s (LA) function and strain in cardiovascular diseases including aortic stenosis (AS), especially for risk stratification and outcome prediction. Cardiac magnetic resonance imaging (CMR) is becoming increasingly useful in determining parameters of LA, however, in patients with AS, this has not been yet approached.

AIMS: The study sought to evaluate the role of CMR in characterizing LA geometry and function in patients with severe AS.

METHODS: We prospectively evaluated 70 patients with symptomatic severe AS and 70 controls. LA volumes, function and strain were determined using CMR. A composite outcome (cardiac death, ventricular tachyarrhythmias, and heart failure hospitalization) was evaluated over a median of 13 months. Time-to-event outcomes were analyzed accordingly.

RESULTS: Besides increased LA volumes (LAVs) and LA sphericity index (LASI) (P <0.001), LA phasic functions and strain were considerably defective in patients with AS (all P <0.001). LV mass (LVM), end-diastolic and end-systolic volumes were also significantly associated withal LA strain parameters (P <0.001). Regarding outcome prediction, decreased total (LA-et), active (LA-ea) and passive strain (LA-ep), along with enhanced LASI were independently associated with outcome (P <0.001). Time-to-event analysis showed significantly higher risk to reach the composite outcome for LA-et <31.1% [HR=6.981; 95%CI (2.74–17.77),  P <0.001)], LA-ep <14.5% [HR = 2.68; 95% CI (1.00–7.18), P<0.01)], and LA-ea <21.2% [HR = 2.02; 95% CI (1.07–3.83), P <0.03].

CONCLUSION: Patients with severe AS have significantly remodelled LA, with impaired phasic function and strain. Amongst all CMR parameters, LAVmin, LASI, LAPF and LA-ep appear to be independent predictors for outcome.

Abstract

BACKGROUND: Emerging studies are beginning to shape the role of afflicted left atrium’s (LA) function and strain in cardiovascular diseases including aortic stenosis (AS), especially for risk stratification and outcome prediction. Cardiac magnetic resonance imaging (CMR) is becoming increasingly useful in determining parameters of LA, however, in patients with AS, this has not been yet approached.

AIMS: The study sought to evaluate the role of CMR in characterizing LA geometry and function in patients with severe AS.

METHODS: We prospectively evaluated 70 patients with symptomatic severe AS and 70 controls. LA volumes, function and strain were determined using CMR. A composite outcome (cardiac death, ventricular tachyarrhythmias, and heart failure hospitalization) was evaluated over a median of 13 months. Time-to-event outcomes were analyzed accordingly.

RESULTS: Besides increased LA volumes (LAVs) and LA sphericity index (LASI) (P <0.001), LA phasic functions and strain were considerably defective in patients with AS (all P <0.001). LV mass (LVM), end-diastolic and end-systolic volumes were also significantly associated withal LA strain parameters (P <0.001). Regarding outcome prediction, decreased total (LA-et), active (LA-ea) and passive strain (LA-ep), along with enhanced LASI were independently associated with outcome (P <0.001). Time-to-event analysis showed significantly higher risk to reach the composite outcome for LA-et <31.1% [HR=6.981; 95%CI (2.74–17.77),  P <0.001)], LA-ep <14.5% [HR = 2.68; 95% CI (1.00–7.18), P<0.01)], and LA-ea <21.2% [HR = 2.02; 95% CI (1.07–3.83), P <0.03].

CONCLUSION: Patients with severe AS have significantly remodelled LA, with impaired phasic function and strain. Amongst all CMR parameters, LAVmin, LASI, LAPF and LA-ep appear to be independent predictors for outcome.

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Keywords

aortic stenosis; cardiac magnetic resonance imaging; left atrial sphericity index; left atrial phasic functions; left atrial strain

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Title

Left atrial geometric and functional remodeling parameters by cardiac magnetic resonance imaging and outcome prediction in patients with severe aortic stenosis

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Online first

Article type

Original article

Published online

2022-11-28

Page views

99

Article views/downloads

34

DOI

10.33963/KP.a2022.0265

Pubmed

36446068

Keywords

aortic stenosis
cardiac magnetic resonance imaging
left atrial sphericity index
left atrial phasic functions
left atrial strain

Authors

Carmen Cionca
Alexandru Zlibut
Rares-Ilie Orzan
Bianca Olivia Cojan-Minzat
Dalma Horvat
Ioana Danuta Muresan
Eva Kiss
Diana Gonciar
Dan Dirzu
Serban Seicean
Lucia Agoston-Coldea
Teodora Mocan

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