PROGNOSTIC VALUE OF DIASTOLIC FUNCTION PARAMETERS IN SIGNIFICANT AORTIC
REGURGITATION. THE ROLE OF THE LEFT ATRIAL STRAIN.
Abstract
Aims. The management of patients with asymptomatic significant aortic
regurgitation (sAR) is often challenging and appropriate timing of
aortic valve surgery remains controversial. Prognostic value of
diastolic parameters has been demonstrated in several cardiac diseases.
In particular, left atrial (LA) function has been shown to be an
important determinant of morbimortality. The purpose of this study was
to analyze the prognostic significance of diastolic function in
asymptomatic patients with sAR. Methods and results. A total of 126
patients with asymptomatic sAR were included. Conventional
echocardiographic systolic and diastolic function parameters were
assessed. LA auto-strain analysis was performed in a subgroup of 57
patients. During a mean follow up of 33±19 months, 25 (19,8%) patients
reached the combined end-point. Univariate analysis showed that LV
volumes, LVEF, E wave, E/e’ ratio, LA volume and LA reservoir strain
(LASr) were significant predictors of events. Multivariate model 1 that
tested all echocardiographic variables statistically significant in the
univariate model showed that LVEDV [HR=1,02;95% CI:1,01-1,03
(p<0,001)] and E/e’ ratio [HR=1,12;95% CI:1,03-1,23
(p=0,01)] were significant predictors of events. In the subgroup of
patients with LA auto-strain analyzed, a second multivariate model
including the previous significant variables for the first model as well
as LASr, showed that LVEDV [HR=1,05;95% CI:1,01-1,08 (p=0,016)] and
LASr [HR=0,8;95% CI:0,65-0,98 (p<0,035)] were the most
significant predictors of cardiovascular events. Conclusions. In this
population of asymptomatic patients with sAR and normal LV systolic
function, baseline diastolic parameters were prognostic markers of
cardiovascular events; among them, LASr played a strong independent
predictor role.