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 Selvanayagam, Fausto J Pinto, José Zamorano, Philippe Pibarot, Arturo Evangelista, Jeroen J Bax, Victoria Delgado
Heart 2021 April 8

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.

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