Department of Cardiology, Ospedale San Giuseppe MultiMedica, Via San Vittore 12, 20123, Milan, Italy.
Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy.
Int J Cardiovasc Imaging. 2021 Jun;37(6):1913-1925. doi: 10.1007/s10554-021-02175-6. Epub 2021 Feb 5.
Left atrial (LA) mechanics assessed by two-dimensional speckle tracking echocardiography (2D-STE) have not been extensively studied and clearly characterized in patients with moderate aortic stenosis (AS). Accordingly, we aimed to evaluate the usefulness of LA reservoir strain for risk stratification of asymptomatic patients with moderate AS. This retrospective study included all consecutive asymptomatic patients with moderate AS who underwent transthoracic echocardiography implemented with 2D-STE analysis of LA myocardial strain and strain rate indices at our Institution, between February 2011 and September 2019. During the follow-up period, we evaluated the occurrence of any of the following: (1) CV hospitalization; (2) The recourse to AS surgery; (3) Cardiac death or sudden death. A total of 186 patients (mean age 71.9 ± 12.7 years, 61.8% men) were included in the present study. During a mean follow-up of 2.3 ± 1.9 years, no patients died and 63 adverse CV events were recorded: 48 patients were hospitalized because of heart failure (28 patients), acute coronary syndrome (10 patients), arrhythmias (10 patients) and 15 patients underwent AS surgery. At the multivariate Cox regression analysis, type 2 diabetes mellitus (OR 1.87, 95%CI 1.05-3.34, p = 0.03), NT-proBNP (OR average 1.14, 95%CI 1.02-1.27, p = 0.02), average E/e' ratio (OR 1.07, 95%CI 1.01-1.15, p = 0.04) and most of all left atrial positive global strain (LA-GSA+) (OR 0.85, 95%CI 0.81-0.90, p < 0.0001) were independently associated with the outcome. LA-GSA+ (optimal cut-off ≤ 19%, AUC = 0.94, 87% sensitivity, 99% specificity, positive predictive value 99%, negative predictive value 88%) showed the highest diagnostic performance. An impaired LA reservoir strain can contribute to identify a subset of asymptomatic patients with moderate AS at higher risk, who may benefit from closer echocardiographic follow-up and/or early surgery.
左心房（LA）力学通过二维斑点追踪超声心动图（2D-STE）评估，在中度主动脉瓣狭窄（AS）患者中尚未得到广泛研究和明确描述。因此，我们旨在评估 LA 储器应变在无症状中度 AS 患者中的风险分层中的作用。本回顾性研究包括 2011 年 2 月至 2019 年 9 月期间在我院接受经胸超声心动图检查并进行二维斑点追踪超声心动图 LA 心肌应变和应变率指数分析的所有连续无症状中度 AS 患者。在随访期间，我们评估了以下任何一种情况的发生：（1）心血管住院；（2）进行 AS 手术；（3）心脏性死亡或猝死。本研究共纳入 186 例患者（平均年龄 71.9±12.7 岁，61.8%为男性）。在平均 2.3±1.9 年的随访中，无患者死亡，记录了 63 例不良心血管事件：48 例因心力衰竭（28 例）、急性冠状动脉综合征（10 例）、心律失常（10 例）住院，15 例行 AS 手术。在多变量 Cox 回归分析中，2 型糖尿病（OR 1.87，95%CI 1.05-3.34，p=0.03）、NT-proBNP（OR 平均 1.14，95%CI 1.02-1.27，p=0.02）、平均 E/e' 比值（OR 1.07，95%CI 1.01-1.15，p=0.04）和最重要的左心房整体应变（LA-GSA+）（OR 0.85，95%CI 0.81-0.90，p<0.0001）与结局独立相关。LA-GSA+（最佳截断值≤19%，AUC=0.94，87%的敏感性，99%的特异性，阳性预测值 99%，阴性预测值 88%）显示出最高的诊断性能。受损的 LA 储器应变有助于识别中度 AS 无症状患者中风险较高的亚组，这些患者可能受益于更密切的超声心动图随访和/或早期手术。
