The left atrium remodeling is associated with adverse outcomes in unoperated degenerative aortic stenosis

Cover Page

Cite item

Full Text

Abstract

Degenerative aortic stenosis (DAS) may be accompanied by remodeling of the left atrium (LA). The aim of the study was to assess the effect of the morpho-functional parameters of the LA remodeling on the prognosis of patients with DAS. The prospective study included 383 patients (men – 33.9% of patients), aged 78.9 ± 0.40 years, with DAS (mild – 18.3%, moderate – 30.8%, severe – 50.9%). The patients did not undergo a surgical correction of the defect. The LA morpho-functional state was estimated by the LA size/volume and the ratio of the rate of the transmitral flow to the rate of the early diastolic movement of the fibrous mitral valve ring (E/e ratio). The average follow-up period was 603.9 ± 24.57 days. The general mortality was assessed. The information on the outcomes was collected by telephone contacts. Multivariate Сox-regression analyses showed that the LA remodeling was independently associated with the death risk: an increase in the LA size ≥45 mm (ОR 1.6, CI 1.06-2.37, р=0.026) and an increase in the Е/е ratio >15 (ОR 1.6, CI 1.08-2.39, р=0.021). Another risk factor was a decrease in the creatinine clearance <45 ml/min (ОR 1.7, CI 1.10-2.60, р=0.016), area of the aortic valve (ОR 0.4, CI 0.26-0.74, р=0.002) and a decrease in the left ventricular ejection fraction <40% (ОR 1.7, CI 1.02-2.71, р=0.042). The Kaplan-Meier survival analysis showed that the E/e ratio>15 and the LА size ≥45 mm were statistically significantly associated with an increased risk of the general mortality (р<0.0001, LogRank=14.5 and р<0.0001, LogRank=18.2, respectively). The areas under the ROC curves for the increased LA size ≥45 mm and the E/e ratio>15 were 0.62 and 0.61, respectively. Thus, the indices of the LA remodeling – the LA size ≥45 mm and the E/e ratio > 15 – are associated with a poor outcome in patients with DAS.

About the authors

V. I. Safaryan

Municipal Clinical Hospital No. 51 of the Moscow Municipal Department of Healthcare

Author for correspondence.
Email: vahtang1985@yandex.ru

врач-терапевт

Russian Federation, Moscow

I. V. Zotova

Central State Medical Academy of the Department of Presidential Affairs of the Russian Federation; Municipal Clinical Hospital No. 17 of the Moscow Municipal Department of Healthcare

Email: irinazotova@bk.ru

к.м.н., доцент кафедры терапии, кардиологии и функциональной диагностики; врач-кардиолог 

Russian Federation, Moscow

T. A. Tipteva

Central State Medical Academy of the Department of Presidential Affairs of the Russian Federation

Email: olgakoroleva@hotmail.com

к.м.н., ассистент кафедры терапии, кардиологии и функциональной диагностики

Russian Federation, Moscow

O. S. Koroleva

Central State Medical Academy of the Department of Presidential Affairs of the Russian Federation

Email: tburyakina@yandex.ru

аспирант кафедры терапии, кардиологии и функциональной диагностики

Russian Federation, Moscow

D. A. Zateyshchikov

Municipal Clinical Hospital No. 51 of the Moscow Municipal Department of Healthcare; Central State Medical Academy of the Department of Presidential Affairs of the Russian Federation; Municipal Clinical Hospital No. 17 of the Moscow Municipal Department of Healthcare

Email: dz@bk.ru

д.м.н., профессор, заведующий первичным сосудистым отделением; заведующий кафедрой терапии, кардиологии и функциональной диагностики; врач-кардиолог 

Russian Federation, Moscow

References

  1. O’Connor K. et al. Left atrial function and remodelling in aortic stenosis // Eur J Echocardiogr. 2011. Vol. 12. No. 4. P. 299–305.
  2. Poulin F. et al. Left atrial phasic function and its association with atrial fibrillation in patients after transcatheter aortic valve implantation // Can J Cardiol. 2017. Vol. 33. No. 7. P. 925–932.
  3. Tsang T.S. et al. Left atrial volume: Important risk marker of incident atrial fibrillation in 1655 older men and women // Mayo Clin Proc. 2001. Vol. 76. No. 5. P. 467-475.
  4. Otto C.M., Pearlman A.S. Doppler echocardiography in adults with symptomatic aortic stenosis. Diagnostic utility and cost-effectiveness // Arch Intern Med. 1988. Vol. 148. No. 12. P. 2553-2560.
  5. Baumgartner H. et al. Determination of aortic valve area by Doppler echocardiography using the continuity equation: A critical evaluation // Cardiology. 1990. Vol. 77. No. 2. P. 101–111.
  6. Baumgartner H. et al. Recommendations on the echocardiographic assessment of aortic valve stenosis: A focused update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography // J Am SocEchocardiogr. 2017. Vol. 30. No. 4. P. 372–392.
  7. Vahanian A. et al. Guidelines on the management of valvular heart disease (version 2012). The Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) // G Ital Cardiol (Rome). 2013. Vol. 14. No. 3. P. 167–214.
  8. Pellikka P.A. et al. Outcome of 622 adults with asymptomatic, hemodynamically significant aortic stenosis during prolonged follow-up // Circulation. 2005. Vol. 111. No. 24. P. 3290–3295.
  9. Greve A.M., Gerdts E., Boman K. et al. Prognostic importance of atrial fibrillation in asymptomatic aortic stenosis: The Simvastatin and Ezetimibe in aortic stenosis study // International Journal of Cardiology. 2013. Vol. 166. No. 1. P. 72–76.
  10. Grimard B.H., Safford R.E., Burns E.L. Aortic stenosis: Diagnosis and treatment // American Family Physician. 2016. Vol. 93. No. 5.
  11. Аrantini G., Mojoli M., Windecker S. et al. Prevalence and impact of atrial fibrillation in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement // An Analysis From the SOURCE XT Prospective Multicenter Registry. 2016. Vol. 9. No. 9. P. 937–946.
  12. Mamas M.A. et al. A meta-analysis of the prognostic significance of atrial fibrillation in chronic heart failure // Eur J Heart Fail. 2009. Vol. 11. No. 7. P. 676–683.
  13. Schulenberg R. et al. Chronic atrial fibrillation is associated with reduced survival after aortic and double valve replacement // Ann Thorac Surg. 2010. Vol. 89. No. 3. P. 738–744.
  14. Levy F. et al. Prognostic value of preoperative atrial fibrillation in patients with aortic stenosis and low ejection fraction having aortic valve replacement // Am J Cardiol. 2006. Vol. 98. No. 6. P. 809–811.
  15. Nagueh S.F. et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging // Eur Heart J Cardiovasc Imaging. 2016. Vol. 17. No. 12. P. 1321–1360.
  16. Wang J.N. et al. Left ventricular filling pressure by septal and lateral E/e’ equally predict cardiovascular events in the general population // Int J Cardiovasc Imaging. 2017. Vol. 33. No. 5. P. 653–661.
  17. Iwahashi N. et al. E/e’ two weeks after onset is a powerful predictor of cardiac death and heart failure in patients with a first-time ST elevation acute myocardial infarction // J Am Soc Echocardiogr. 2012. Vol. 25. No. 12. P. 1290–1298.
  18. Acil T. et al. Prognostic value of tissue Doppler imaging in patients with chronic congestive heart failure // Int J Cardiol. 2005. Vol. 103. No. 2. P. 175-181.
  19. Takemoto Y. et al. Usefulness of left atrial volume in predicting first congestive heart failure in patients > or = 65 years of age with well-preserved left ventricular systolic function // Am J Cardiol. 2005. Vol. 96. No. 6. P. 832–836.
  20. Benjamin E.J. et al. Left atrial size and the risk of stroke and death. The Framingham Heart Study // Circulation. 1995. Vol. 92. No. 4. P. 835–841.
  21. Мурсалимова А.И., Гендлин Г.Е., Сторожаков Г.И. и др. Особенности течения изолированного аортального стеноза у женщин // Проблемы женского здоровья. 2013. Т. 8. № 4. С. 33–42.
  22. Мурсалимова А.И., Гендлин Г.Е., Сторожаков Г.И. и др. Кальцинированный аортальный клапан // Доктор.Ру. 2013. № 2 (80). С. 5–10.
  23. Fatema K. et al. Minimum vs. maximum left atrial volume for prediction of first atrial fibrillation or flutter in an elderly cohort: A prospective study // Eur J Echocardiogr. 2009. Vol. 10. No. 2. P. 282-286.
  24. Elliott P.M. et al. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: The task force for the diagnosis and management of hypertrophic cardiomyopathy of the European Society of Cardiology (ESC) // Eur Heart J. 2014. Vol. 35(39). P. 2733–2779.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. Kaplan – Meier survival curves. A: survival of patients with DAS, depending on the magnitude of the ratio of the velocity of the transmitral flux to the velocity of the early diastolic movement of the fibrous ring of the mitral valve (E / e ratio) B: survival of patients with DAS, depending on the size of the left atrium (LP)

Download (219KB)
Indexing metadata

Copyright (c) 2018 Safaryan V.I., Zotova I.V., Tipteva T.A., Koroleva O.S., Zateyshchikov D.A.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies