title: Left atrial volume as predictor of valve replacement and cardiovascular events in patients with asymptomatic mild to moderate aortic stenosis.
abstract: BACKGROUND
  Left atrial (LA) size is known to increase with chronically increased left ventricular (LV) filling pressure. We hypothesized that LA volume was predictive of aortic valve replacement (AVR) and cardiovascular events in a large cohort of patients with asymptomatic mild to moderate aortic valve stenosis.
  
  
  METHODS
  Transthoracic echocardiography was performed in 1,758 patients in the Simvastatin and Ezetemibe in Aortic Stenosis study. LA volume was measured in the apical four-chamber view in 1,503 patients (85%). The relation of LA volume to AVR or a combined endpoint of cardiovascular events (AVR, congestive heart failure due to aortic stenosis or death from cardiovascular causes) was evaluated.
  
  
  RESULTS
  AVR was performed in 415 (28%) patients, whereas 505 (34%) reached the combined endpoint. A significant but weak association of increased LA volume and risk of the combined endpoint was found (log-rank test: P = 0.02), but this relation did not reach any significance in a multivariate model adjusting for age, gender, aortic valve area index, LV ejection fraction, LV hypertrophy, hypertension, and mitral regurgitation. LA volume was not predictive of AVR (log-rank test: P = 0.3).
  
  
  CONCLUSIONS
  In asymptomatic patients with mild to moderate Aortic valve stenosis (AS), LA volume was not predictive of the combined endpoint of Aortic valve replacement, development of heart failure or cardiac death. AVA and presence of LV hypertrophy were the only predictors of events in multivariate analysis.
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: Dalsgaard
authors.forename: Kenneth
authors.initials: K
authors.lastname: Egstrup
authors.forename: Kristian
authors.initials: K
authors.lastname: Wachtell
authors.forename: Dana
authors.initials: D
authors.lastname: Cramariuc
authors.forename: Jesper
authors.initials: J
authors.lastname: Kjaergaard
authors.forename: Eva
authors.initials: E
authors.lastname: Gerdts
authors.forename: Christian
authors.initials: C
authors.lastname: Hassager
mesh_terms: D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D015984:Causality; D015331:Cohort Studies; D015897:Comorbidity; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D003718:Denmark / Q000453:epidemiology; D004311:Double-Blind Method; D004452:Echocardiography / Q000706:statistics & numerical data*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006333:Heart Failure / Q000378:metabolism*; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality*; D006801:Humans; D015994:Incidence; D008297:Male; D009929:Organ Size; D011183:Postoperative Complications / Q000401:mortality*; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015996:Survival Rate; D016896:Treatment Outcome
keywords: aortic valve replacement; aortic valve stenosis; events; left atrial volume