A1 Vertaisarvioitu alkuperäisartikkeli tieteellisessä lehdessä
Prognostic implications of left atrial dilation in aortic regurgitation due to bicuspid aortic valve
Tekijät: Butcher Steele C, Fortuni Federico, Kong William, Vollema E Mara, Prevedello Francesca, Perry Rebecca, Ng Arnold Chin Tse, Poh Kian Keong, Almeida Ana G, Gonzalez-Gomez Ariana, Shen Mylène, Yeo Tiong-Chen, Shanks Miriam, Popescu Bogdan A, Galian-Gay Laura, Fijalkowski Marcin, Liang Michael, Tay Edgar, Marsan Nina Ajmone, Selvanayagam Joseph B, Pinto Fausto J, Zamorano José, Pibarot Philippe, Evangelista Arture, Bax Jeroen J, Delgado Victoria
Kustantaja: BMJ PUBLISHING GROUP
Julkaisuvuosi: 2022
Journal: Heart
Tietokannassa oleva lehden nimi: HEART
Lehden akronyymi: HEART
Vuosikerta: 108
Numero: 2
Aloitussivu: 137
Lopetussivu: 144
Sivujen määrä: 8
ISSN: 1355-6037
eISSN: 1468-201X
DOI: https://doi.org/10.1136/heartjnl-2020-318907
Verkko-osoite: https://heart.bmj.com/content/108/2/137
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.
