Department of Cardiac Surgery, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
Department of Cardiology, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
J Thorac Cardiovasc Surg. 2017 Jun;153(6):1275-1284.e7. doi: 10.1016/j.jtcvs.2017.01.054. Epub 2017 Feb 9.
The enlargement of the left atrium has been identified as a marker of chronically increased left ventricular filling pressure and left ventricular diastolic dysfunction. This study aims to evaluate the association of indexed left atrial diameter with stroke, cardiovascular mortality, the combined event, and all-cause mortality in patients who underwent aortic valve surgery.
Indexed left atrial diameter was measured in 2011 adult patients (mean age, 70.9 ± 10.8 years; 58.7% were men) who underwent aortic valve surgery between January 2008 and March 2016.
On the basis of the criteria of the American Society of Echocardiography, indexed left atrial diameter was normal in 64% of patients, mildly enlarged in 12.4% of patients, moderately enlarged in 9.2% of patients, and severely enlarged in 14.3% of patients. Over a mean follow-up period of 3.2 ± 2.1 years, there were 334 deaths and 97 strokes. Cardiovascular mortality survival at 5 years among patients with normal, mild, moderate, and severe left atrial enlargement was 91.6%, 86.8%, 77.9%, and 77.4%, respectively (P < .001). After covariable adjustment, Cox regression analysis showed indexed left atrial diameter as an independent predictor of all-cause mortality (hazard ratio per 1-cm/m increment, 1.545; 95% confidence interval, 1.252-1.906, P < .001), cardiovascular death (hazard ratio per 1-cm/m increment, 1.971; 95% confidence interval, 1.541-2.520; P < .001), and the combined event (hazard ratio per 1-cm/m increment, 1.673; 95% confidence interval, 1.321-2.119; P < .001).
Indexed left atrial diameter is a strong predictor of long-term outcomes in patients with aortic valve diseases who undergo surgery.
左心房扩大已被确定为慢性左心室充盈压升高和左心室舒张功能障碍的标志物。本研究旨在评估经胸超声心动图测量的左心房内径指数（LADi）与接受主动脉瓣置换术患者的卒中、心血管死亡率、复合终点事件和全因死亡率之间的相关性。
纳入 2011 例于 2008 年 1 月至 2016 年 3 月期间接受主动脉瓣置换术的成年患者（平均年龄 70.9±10.8 岁，58.7%为男性），测量其 LADi。
根据美国超声心动图学会的标准，64%的患者 LADi 正常，12.4%的患者轻度增大，9.2%的患者中度增大，14.3%的患者重度增大。在平均 3.2±2.1 年的随访期间，共有 334 例死亡和 97 例卒中。LADi 正常、轻度增大、中度增大和重度增大患者的 5 年心血管死亡率分别为 91.6%、86.8%、77.9%和 77.4%（P<.001）。经多变量调整后，Cox 回归分析显示 LADi 是全因死亡率（每增加 1-cm/m 的风险比，1.545；95%置信区间，1.252-1.906，P<.001）、心血管死亡（每增加 1-cm/m 的风险比，1.971；95%置信区间，1.541-2.520；P<.001）和复合终点事件（每增加 1-cm/m 的风险比，1.673；95%置信区间，1.321-2.119；P<.001）的独立预测因子。
LADi 是接受主动脉瓣疾病手术患者长期预后的强有力预测因子。
