Left atrial strain as a predictor of atrial fibrillation in patients with asymptomatic severe aortic stenosis and preserved left ventricular systolic function

Aim. To study the structural and functional left heart parameters in patients with severe aortic stenosis (AS) and preserved ejection fraction (EF) in order to determine the risk of atrial fibrillation (AF).

Material and methods. The study included 84 patients (men, 37; mean age, 68±8 years) with severe AS and EF >55%. All patients had sinus rhythm and were asymptomatic. Echocardiography was performed to assess longitudinal strain of the left ventricle (LVLS), right ventricle, left atrium (LALS) and the left atrial stiffness (LAS) using the speckle tracking method. Left ventricular mass index (LVMI) and maximum left atrium volume index (LAVI) were also determined. Patients were followed up for 1 year.

Results. AF was reported in 27 (32%) patients, of which 9 (33%) had asymptomatic AF episodes detected by 48-hour electrocardiography. Eighteen (67%) patients with AF felt palpitations. Patients with and without episodes of atrial fibrillation had non-significant differences in LVMI, LAVI, and LVLS. Patients with atrial fibrillation had a lower LALS and a higher LAS compared with patients without atrial fibrillation. Regression analysis revealed that LALS and LAS were independent predictors of AF.

Conclusion. AF develops in about one third of asymptomatic patients with severe AS and normal EF. The development of AF predisposes to the onset of AS symptoms in most patients. LALS and LAS were predictors of AF in these patients. Identification of patients at risk of AF will allow for earlier aortic valve replacement.

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