title: Association of left atrial booster-pump function with heart failure symptoms in patients with severe aortic stenosis and preserved left ventricular ejection fraction.
abstract: BACKGROUND
  Identification of heart failure (HF) symptoms in patients with severe aortic stenosis (AS) and preserved left ventricular (LV) ejection fraction (EF) is clinically important, but assessment of HF symptoms is challenging. It was recently reported that resting left atrium (LA) functions are related to exercise performance and are also important prognostic markers for patients with HF. The aim of this study was to assess the association of the HF symptoms with LA function in patients with severe AS and preserved LVEF.
  
  
  METHODS
  We retrospectively studied 40 patients with severe AS and preserved LVEF (all ≥50%) who were referred for aortic valve replacement (AVR). LA reservoir (SR-LAs), conduit (SR-LAe), and booster-pump (SR-LAa) functions were determined as the averaged global LA speckle tracking longitudinal strain rate from apical four- and two-chamber views. Twenty patients were symptomatic and 20 asymptomatic.
  
  
  RESULTS
  Aortic stenosis severity was similar for the 2 groups. Symptomatic status was associated with age, LV mass index, hemoglobin, B-type natriuretic peptide, LV end-systolic volume index, LVEF, LA volume index, SR-LAs, SR-LAe, and SR-LAa. Importantly, multivariate logistic regression analysis revealed that SR-LAa was the only independent determinant of symptomatic status (OR = 0.242, P = 0.002). Furthermore, significant improvement of SR-LAa was observed along with the reduction in LA volume index and LV mass index after AVR.
  
  
  CONCLUSIONS
  SR-LAa was found to be associated with the HF symptoms. Characterization of LA booster-pump function may be useful for the assessment of the symptomatic status in patients with severe AS patients and limited physical activity.
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Imanishi
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Tanaka
authors.forename: Takuma
authors.initials: T
authors.lastname: Sawa
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Motoji
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Miyoshi
authors.forename: Yasuhide
authors.initials: Y
authors.lastname: Mochizuki
authors.forename: Yuko
authors.initials: Y
authors.lastname: Fukuda
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Tatsumi
authors.forename: Kensuke
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Okita
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Hirata
mesh_terms: D000367:Age Factors; D000368:Aged; D001024:Aortic Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging*; D016279:Atrial Function, Left / Q000502:physiology*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging*; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014463:Ultrasonography; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D020097:Natriuretic Peptide, Brain
keywords: aortic stenosis; echocardiography; left atrium; strain rate imaging