P1025Comparative assessment of left atrial function in patients with isolated aortic stenosis versus pure chronic aortic regurgitation


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Abstract

Background: In patients (pts) with significant aortic valve disease the left ventricle reacts to pressure and volume overload by concentric or eccentric remodelling and hypertrophy (LVH). In these pts, left atrial (LA) function plays an important role in maintaining optimal cardiac output despite impaired LV relaxation and altered LV compliance.Purpose: To assess LA strain ([Latin Small Letter Open E]) and strain-rate (Sr) by speckle tracking echocardiography in pts with severe aortic stenosis (AS) and in pts with moderate and severe chronic aortic regurgitation (AR), both with preserved LV ejection fraction (>50%) and similar degree of LA dilation.Methods: We prospectively enrolled 27 pts (55±9 years, 22 men) with isolated severe AS (AVAi 0.4 ±0.1 cm2/m2, mean transvalvular gradient 52±18 mmHg) and 28 pts with isolated moderate and severe chronic AR (49±18 years, 21 men). A comprehensive echocardiogram was performed in all, including TDI-derived parameters of LV systolic and diastolic function. LV filling pressures were assessed using Eseptal/E' ratio. Longitudinal LA strain parameters were assessed from apical 4-chamber view using a 2D strain software. Peak values of global LA[Latin Small Letter Open E] and LA systolic Sr (SSr, reservoir function), early diastolic Sr (ESr, conduit function) and late diastolic Sr (ASr, booster pump function) were measured in all pts.Results: Age, gender and body mass index were similar in both groups (p >0.10 for all). Pts in the AR group had higher LV diameters and volumes (p<0.004), lower relative LV wall thickness (p<0.001) but similar indexed LV mass (152±42 vs 141±32 g/m2, p=0.3), LV ejection fraction (59±6 vs 60±6%, p=0.6) and indexed LA volume (33±11 vs 38± 13 ml/m2, p=0.1). Pts with AS had higher E/E' ratios (13.3±3.7 vs 9.4± 2.4 p<0.001) and significantly lower septal systolic myocardial velocities (5.9±1.4 vs 7.0±1.8 cm/s, p=0.02). In pts with AS, both peak LA[Latin Small Letter Open E] and SSr were significantly lower than in pts with AR (22±8 vs 26 ±8%, p=0.035 and 0.9±0.2 vs 1.3 ±0.5 s-1, p=0.004) reflecting a poorer LA reservoir function. ESr and ASr were not significantly different between groups (-0.8±0.3 vs 1.0 ±0.6 s-1, p=0.06; -1.3±0.5 vs -1.5±0.6 s-1, p=0.2, respectively). In pts with AS significant correlations were found between LA[Latin Small Letter Open E] and SSr and peak septal systolic myocardial velocity (r=0.53, p=0.005 and r=0.52, p=0.006 respectively).Conclusions: Patients with AS have greater impairment of LA reservoir function than pts with AR, despite similar LV mass and LA size. The reduction of LA reservoir function in these pts is related to decreased longitudinal LV function, showing the close interplay between LA and LV function.

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