Relation of Left Atrial Size, Cardiac Morphology, and Clinical Outcome in Asymptomatic Aortic Stenosis

Nicolaj Lyhne Christensen, Jordi Dahl, Rasmus Carter-Storch, Rine Bakkestrøm, Redi Pecini, Flemming Hald Steffensen, Eva Søndergaard, Lars Videbæk, Jacob Eifer Møller

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Left atrial (LA) dilatation in asymptomatic severe aortic stenosis (AS) may be an indicator of advanced disease. The aim was to investigate the association between LA volume index (LAVi) and left ventricular (LV) morphology assessed with cardiac magnetic resonance imaging (cMRI), and to assess the association with cardiac events in asymptomatic AS. Ninety-two asymptomatic patients with aortic valve area (AVA) <1 cm² and aortic peak jet velocity > 3.5 m/s, and ejection fraction ≥ 50% were prospectively enrolled. Patients were divided according to echocardiographic-derived LAVi < 35 ml/m². Patients underwent echocardiography, cMRI, exercise test, and patients were followed for the composite endpoint of death, readmission or aortic valve replacement. AVA index was similar (0.45 ± 0.08 cm² /m² vs. 0.45 ± 0.09 cm², p=0.85) in patients with a dilated and normal LA. On cMRI patients with dilated LA were characterized by higher LV mass index (73 ± 17 g/m² vs. 66 ± 16 g/m² , p=0.03), increased right ventricle (70 ± 14 ml/m² vs. 63 ± 12 ml/m², p=0.01) and LV end-diastolic volume index (84 ± 18 ml/m² vs. 77 ± 16 ml/m², p=0.05), and higher brain natriuretic peptide (BNP). No difference in late enhancement was seen between groups. During follow-up 28 events were recorded 20 in patients with LA dilatation compared to 8 in patients with a normal LA (adjusted hazard ratio 2.77, 95% confidence interval 1.19-6.46, p=0.02), also BNP > 125 pg/ml was associated with adverse outcome (adjusted hazard ratio of 3.63 (95% CI interval 1.28-10.32, p=0.02). LA dilatation is associated with adverse LV remodeling and provides important prognostic information in severe asymptomatic AS.
Original languageEnglish
JournalThe American Journal of Cardiology
Volume120
Issue number10
Pages (from-to)1877-1883
ISSN0002-9149
DOIs
Publication statusPublished - 2017

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Dilatation
Brain Natriuretic Peptide
Ventricular Remodeling
Exercise Test
Heart Ventricles
Echocardiography
Confidence Intervals

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Christensen, Nicolaj Lyhne ; Dahl, Jordi ; Carter-Storch, Rasmus ; Bakkestrøm, Rine ; Pecini, Redi ; Hald Steffensen, Flemming ; Søndergaard, Eva ; Videbæk, Lars ; Møller, Jacob Eifer . / Relation of Left Atrial Size, Cardiac Morphology, and Clinical Outcome in Asymptomatic Aortic Stenosis. In: The American Journal of Cardiology. 2017 ; Vol. 120, No. 10. pp. 1877-1883.
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abstract = "Left atrial (LA) dilatation in asymptomatic severe aortic stenosis (AS) may be an indicator of advanced disease. The aim was to investigate the association between LA volume index (LAVi) and left ventricular (LV) morphology assessed with cardiac magnetic resonance imaging (cMRI), and to assess the association with cardiac events in asymptomatic AS. Ninety-two asymptomatic patients with aortic valve area (AVA) <1 cm² and aortic peak jet velocity > 3.5 m/s, and ejection fraction ≥ 50{\%} were prospectively enrolled. Patients were divided according to echocardiographic-derived LAVi < 35 ml/m². Patients underwent echocardiography, cMRI, exercise test, and patients were followed for the composite endpoint of death, readmission or aortic valve replacement. AVA index was similar (0.45 ± 0.08 cm² /m² vs. 0.45 ± 0.09 cm², p=0.85) in patients with a dilated and normal LA. On cMRI patients with dilated LA were characterized by higher LV mass index (73 ± 17 g/m² vs. 66 ± 16 g/m² , p=0.03), increased right ventricle (70 ± 14 ml/m² vs. 63 ± 12 ml/m², p=0.01) and LV end-diastolic volume index (84 ± 18 ml/m² vs. 77 ± 16 ml/m², p=0.05), and higher brain natriuretic peptide (BNP). No difference in late enhancement was seen between groups. During follow-up 28 events were recorded 20 in patients with LA dilatation compared to 8 in patients with a normal LA (adjusted hazard ratio 2.77, 95{\%} confidence interval 1.19-6.46, p=0.02), also BNP > 125 pg/ml was associated with adverse outcome (adjusted hazard ratio of 3.63 (95{\%} CI interval 1.28-10.32, p=0.02). LA dilatation is associated with adverse LV remodeling and provides important prognostic information in severe asymptomatic AS.",
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Relation of Left Atrial Size, Cardiac Morphology, and Clinical Outcome in Asymptomatic Aortic Stenosis. / Christensen, Nicolaj Lyhne ; Dahl, Jordi; Carter-Storch, Rasmus ; Bakkestrøm, Rine; Pecini, Redi; Hald Steffensen, Flemming; Søndergaard, Eva; Videbæk, Lars; Møller, Jacob Eifer .

In: The American Journal of Cardiology, Vol. 120, No. 10, 2017, p. 1877-1883.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Relation of Left Atrial Size, Cardiac Morphology, and Clinical Outcome in Asymptomatic Aortic Stenosis

AU - Christensen, Nicolaj Lyhne

AU - Dahl, Jordi

AU - Carter-Storch, Rasmus

AU - Bakkestrøm, Rine

AU - Pecini, Redi

AU - Hald Steffensen, Flemming

AU - Søndergaard, Eva

AU - Videbæk, Lars

AU - Møller, Jacob Eifer

PY - 2017

Y1 - 2017

N2 - Left atrial (LA) dilatation in asymptomatic severe aortic stenosis (AS) may be an indicator of advanced disease. The aim was to investigate the association between LA volume index (LAVi) and left ventricular (LV) morphology assessed with cardiac magnetic resonance imaging (cMRI), and to assess the association with cardiac events in asymptomatic AS. Ninety-two asymptomatic patients with aortic valve area (AVA) <1 cm² and aortic peak jet velocity > 3.5 m/s, and ejection fraction ≥ 50% were prospectively enrolled. Patients were divided according to echocardiographic-derived LAVi < 35 ml/m². Patients underwent echocardiography, cMRI, exercise test, and patients were followed for the composite endpoint of death, readmission or aortic valve replacement. AVA index was similar (0.45 ± 0.08 cm² /m² vs. 0.45 ± 0.09 cm², p=0.85) in patients with a dilated and normal LA. On cMRI patients with dilated LA were characterized by higher LV mass index (73 ± 17 g/m² vs. 66 ± 16 g/m² , p=0.03), increased right ventricle (70 ± 14 ml/m² vs. 63 ± 12 ml/m², p=0.01) and LV end-diastolic volume index (84 ± 18 ml/m² vs. 77 ± 16 ml/m², p=0.05), and higher brain natriuretic peptide (BNP). No difference in late enhancement was seen between groups. During follow-up 28 events were recorded 20 in patients with LA dilatation compared to 8 in patients with a normal LA (adjusted hazard ratio 2.77, 95% confidence interval 1.19-6.46, p=0.02), also BNP > 125 pg/ml was associated with adverse outcome (adjusted hazard ratio of 3.63 (95% CI interval 1.28-10.32, p=0.02). LA dilatation is associated with adverse LV remodeling and provides important prognostic information in severe asymptomatic AS.

AB - Left atrial (LA) dilatation in asymptomatic severe aortic stenosis (AS) may be an indicator of advanced disease. The aim was to investigate the association between LA volume index (LAVi) and left ventricular (LV) morphology assessed with cardiac magnetic resonance imaging (cMRI), and to assess the association with cardiac events in asymptomatic AS. Ninety-two asymptomatic patients with aortic valve area (AVA) <1 cm² and aortic peak jet velocity > 3.5 m/s, and ejection fraction ≥ 50% were prospectively enrolled. Patients were divided according to echocardiographic-derived LAVi < 35 ml/m². Patients underwent echocardiography, cMRI, exercise test, and patients were followed for the composite endpoint of death, readmission or aortic valve replacement. AVA index was similar (0.45 ± 0.08 cm² /m² vs. 0.45 ± 0.09 cm², p=0.85) in patients with a dilated and normal LA. On cMRI patients with dilated LA were characterized by higher LV mass index (73 ± 17 g/m² vs. 66 ± 16 g/m² , p=0.03), increased right ventricle (70 ± 14 ml/m² vs. 63 ± 12 ml/m², p=0.01) and LV end-diastolic volume index (84 ± 18 ml/m² vs. 77 ± 16 ml/m², p=0.05), and higher brain natriuretic peptide (BNP). No difference in late enhancement was seen between groups. During follow-up 28 events were recorded 20 in patients with LA dilatation compared to 8 in patients with a normal LA (adjusted hazard ratio 2.77, 95% confidence interval 1.19-6.46, p=0.02), also BNP > 125 pg/ml was associated with adverse outcome (adjusted hazard ratio of 3.63 (95% CI interval 1.28-10.32, p=0.02). LA dilatation is associated with adverse LV remodeling and provides important prognostic information in severe asymptomatic AS.

U2 - 10.1016/j.amjcard.2017.07.101

DO - 10.1016/j.amjcard.2017.07.101

M3 - Journal article

VL - 120

SP - 1877

EP - 1883

JO - The American Journal of Cardiology

JF - The American Journal of Cardiology

SN - 0002-9149

IS - 10

ER -