Left atrial (LA) function is increasingly used to predict cardiovascular events.

We tested the relationship between LA strain (Las) and left ventricular dysfunction and prognosis in aortic stenosis (AS).

Transthoracic Doppler echocardiography was performed prospectively in 98 consecutive patients with AS (63 with severe, 35 with moderate AS, mean age 77±10 years, 49% women, mean aortic valve area 0.5±0.15cm², mean LVEF 63±13%). LA volume was calculated by the area-length method in apical four-and two-chamber views and indexed to body surface area. Las (mean of maximal strain from the 4-2-3 chamber views) was conducted using a dedicated software package, using R-R gating. The end-point was hospitalization for heart failure and death from any cause.

Las, and LA volume/mLas were significantly correlated to E/A, E/e’, and pulmonary artery systolic pressure (all, P<0.05). However, Las but not LA volume/m² was significantly correlated to comorbidities index (Charlson, Euroscore), LVEF, stroke volume/m², as well as peak aortic jet velocity (all, P<0.05). At a median follow-up of 25 months, 48 patients had an event. Las, LA volume/m², as well as Charlson index, diabetes, and DTI parameters were associated to events (all, P<0.05). In multivariate analysis, Las (P<0.01) and Charlson index (P<0.05) remained independently associated to events. Using a ROC curve analysis, a Las<17% (AUC=0.73±0.05) was the best cutoff to predict an event at follow-up.

In patients with moderate to severe AS, Las is associated with LV diastolic and systolic dysfunction, AS severity, and is independently linked to events.