title: Left atrial systolic force in asymptomatic aortic stenosis.
abstract: BACKGROUND
  There is a limited knowledge about left atrial (LA) systolic force (LASF) and its key determinants in patients with asymptomatic mild-moderate aortic stenosis (AS).
  
  
  METHODS
  We used baseline clinic and echocardiographic data from 1,566 patients recruited in the simvastatin ezetimibe in aortic stenosis study evaluating the effect of placebo-controlled combined simvastatin and ezetimibe treatment in asymptomatic AS. The LASF was calculated by Manning's method. Low and high LASF were defined as <5th and >95th percentile of the distribution within the study population, respectively.
  
  
  RESULTS
  Mean LASF in the total study population was 21±14 kdynes/cm2. The determinants of LASF were higher age, heart rate, body mass index, systolic blood pressure, left ventricular (LV) mass, mitral peak early velocity, maximal LA volume, and longer mitral deceleration time (multiple R2=0.37, P<0.01). High LASF (78 patients) was characterized by abnormal LV relaxation in 90% of the cases. Low LASF (82 patients) was associated with restrictive LV filling pattern, absence of abnormal relaxation pattern, smaller maximal LA volume, and lower body mass index. In 40% of the patients with low LASF, estimated LV filling pressures were normal and the reduced LA force was explainable by an intrinsic systolic LA dysfunction.
  
  
  CONCLUSIONS
  In patients with asymptomatic AS, LASF was closely related to filling pressure. Higher LASF invariably signifies the maximal LA effort to keep near normal LV filling pressure; lower LASF belongs to a heterogeneous group of patients in which it is much more difficult to depict who have low LA preload or who have intrinsic systolic LA dysfunction.
authors.affiliation: Department of Cardiology, Villa Bianca Hospital, Trento, Italy. gcloffi@villablancatrento.i
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cioffi
authors.forename: Dana
authors.initials: D
authors.lastname: Cramariuc
authors.forename: Morten
authors.initials: M
authors.lastname: Dalsgaard
authors.forename: Einar Skulstad
authors.initials: ES
authors.lastname: Davidsen
authors.forename: Kenneth
authors.initials: K
authors.lastname: Egstrup
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Simone
authors.forename: Eva
authors.initials: E
authors.lastname: Gerdts
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000503:physiopathology*; D001384:Azetidines / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology; D015992:Body Mass Index; D016009:Chi-Square Distribution; D015150:Echocardiography, Doppler; D000069438:Ezetimibe; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006334:Heart Function Tests; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D012307:Risk Factors; D019821:Simvastatin / Q000627:therapeutic use; D013599:Systole / Q000502:physiology*
chemical_list: D000924:Anticholesteremic Agents; D001384:Azetidines; D019821:Simvastatin; D000069438:Ezetimibe