Peak atrial longitudinal strain and risk stratification in moderate and severe aortic stenosis

doi:10.1093/ehjci/jeae040

Peak atrial longitudinal strain and risk stratification in moderate and severe aortic stenosis

Eur Heart J Cardiovasc ImagingPublished 6 Feb 2024Cohort study

Main finding · Composite of all-cause mortality and HF hospitalizationResultAdjusted hazard ratio 0.95 95% CI 0.91–0.99

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Authors' conclusion

In our patients with at least moderate AS, PALS was independently associated with outcome.

Study context

Population: Patients with at least moderate aortic stenosis (AS) and sinus rhythm (mean age 80.6 ± 8.2 years; 51% men)96 events
Participants: 467 patients

Exposure: Peak atrial longitudinal strain (PALS) <16% vs ≥16%
Outcome: Composite of:
All-cause mortality
HF hospitalizations
Follow-up: Median 19.2 (IQR 12.5-24.4) months

Main finding

As reported in the abstract

Composite of:

All-cause mortality
HF hospitalization

· median follow-up 19.2 months

Adjusted hazard ratio

0.95

95% CI 0.91–0.99

P = 0.017

By group

PALS <16%

0.70

AUC

PALS vs PALS ≥ 16%

aHR 0.95 (95% CI 0.91–0.99); P = 0.017

Higher event rate with PALS < 16% (Kaplan-Meier): log-rank P < 0.001

Observational data: associations, not effects.

Further findings

Outcome	← Lower risk with PALS ←→ Higher risk with PALS →	aHR (95% CI)	P value
Composite endpoint, by subgroup (paucisymptomatic, moderate AS, low-flow AS) — PALS vs PALS ≥ 16% · paucisymptomatic	0.512	0.98 (0.97–0.98)	P = 0.048
Composite endpoint, by subgroup (paucisymptomatic, moderate AS, low-flow AS) — PALS vs PALS ≥ 16% · moderate AS	0.512	0.92 (0.86–0.98)	P = 0.016
Composite endpoint, by subgroup (paucisymptomatic, moderate AS, low-flow AS) — PALS vs PALS ≥ 16% · low-flow AS	0.512	0.90 (0.83–0.98)	P = 0.020
	0.512Adjusted hazard ratio (log scale)

Incremental prognostic value

PALS provided incremental prognostic value over left ventricular (LV) global longitudinal strain, LVEF and RV function

Original publication

Peak atrial longitudinal strain and risk stratification in moderate and severe aortic stenosis. Eur Heart J Cardiovasc Imaging. Published 6 February 2024. doi:10.1093/ehjci/jeae040

Read the original article ↗PubMed

Summarised from the published abstract; every number is checked against it