Prognostic value of left atrial strain in patients with congenital aortic stenosis

Aim To explore whether left atrial (LA) strain with speckle tracking echocardiography (STE) can contribute to prognostication in patients with congenital aortic stenosis (CAS). Methods and results In this prospective study, consecutive outpatients with stable CAS and healthy adults were enrolled between 2011 and 2015. Left atrial function was analysed with STE using Tomtec software. Associations between LA strain (LAS) measurements and primary composite outcome (any adverse cardiovascular event, hospitalization, or re-intervention) and secondary outcome (re-interventions) were assessed with Cox regression analysis. In total, 98 patients with CAS (mean age: 35.0+11.9 year, female: 59.2%) and 121 controls (age: 43.9+13.8 year, female: 55.4%) were included. The majority of patients were in NYHA class I: 97 (99%) at baseline. At baseline, LA conduit strain (LAS-cd) and strain rate (LASR-cd) were significantly lower in patients than in controls when corrected for age and sex (-18.1+8.7 vs. -23.5+9.9%, P= 0.001 and -0.73+0.31 vs. -1.02+0.43/s, P,0.001). During a median follow-up of 6.4 years (5.7-7.1), the primary composite outcome occurred in 48 (39.6%) patients. Kaplan-Meier analysis showed that decreased LAS-cd (,21%) was associated with a higher occurrence of the primary outcome (log-rank: P=0.008). Depressed LAS-cd and LASR-cd were both associated with the primary composite outcome [univariable hazard ratio (HR)=0.64(0.46-0.88), P=0.005 and HR=0.68(0.55-0.83), P,0.001, respectively]; adjusted HR (for LAS-cd and LASR-cd, respectively): 0.31(0.09-1.04), P=0.06 and 0.49(0.26-0.89), P=0.02. Conclusion Impairment in LA conduit function assessed with STE carries prognostic value in patients with CAS and can be implemented in clinical management.