Left atrial function and remodelling in aortic stenosis

TLDR: In AS, changes in LA function did not parallel changes inLA size, and the increase in LA volume does not necessarily reflect the presence of intrinsic LA dysfunction, and no LA phasic strain parameters emerged as independently associated with LAphasic volume parameters.

Abstract: Aims The present study sought to determine the relationship between left atrial (LA) volume (structural changes) and LA function as assessed by strain rate imaging in patients with aortic stenosis (AS). Methods and results The study consisted of a total of 64 consecutive patients with severe AS (<1 cm²) and 20 healthy control subjects. The phasic LA volumes and function (tissue Doppler-derived strain) were assessed in all patients. As compared with healthy controls, all strain-derived parameters of LA function were reduced in patients with AS. Conversely, only indexed LA passive volume (increased) (7.6 ± 3.8 vs. 10.5 ± 5.1 ml/m², P = 0.02) and LA active fraction (decreased) (43 ± 6.7 vs. 31 ± 13.3%, P < 0.001) (volume-based parameters) were significantly different between AS and controls. In AS, LA volume-derived function parameters were poorly correlated with LA strain parameters. In fact, by multivariable analysis, no LA phasic strain parameters emerged as independently associated with LA phasic volume parameters. Conclusions In AS, changes in LA function did not parallel changes in LA size. Furthermore, the increase in LA volume does not necessarily reflect the presence of intrinsic LA dysfunction.