Noninvasive assessment of filling pressure and left atrial pressure overload in severe XXXX : relation to ventricular remodeling and clinical outcome after aortic valve replacement.

@entity1 @entity712 @entity384 @entity4346 @entity472
OBJECTIVE: One of the hemodynamic consequences of @entity472 is pressure overload leading to left @entity384 . Left atrial size is a known risk factor providing prognostic information in several cardiac conditions. It is not known if this is also the case in @entity1 with @entity472 after aortic valve replacement. METHODS: A total of 119 @entity1 with severe @entity472 scheduled for aortic valve replacement were evaluated preoperatively and divided into 2 groups according to left atrial volume index (>= 40 mL/m(2)). Echocardiography was repeated 12 months after surgery. @entity1 were followed up for 24 months. The primary end point was the composite end point overall mortality and hospitalization due to @entity712 . RESULTS: Preoperative left atrial dilation was associated with @entity4346 and increased filling pressure. Preoperative left atrial volume index was associated with persistent abnormalities in left ventricular filling pressure and left ventricular mass index at 1 year after surgery. Event-free survival in @entity1 with left atrial volume index of 40 mL/m(2) or more at 1 year was 71% compared with 88% in @entity1 with left atrial volume index less than 40 mL/m(2) (P = .002). @entity1 with preoperative increased E/e' ratio and @entity4346 were at increased risk. In Cox regression analysis after correcting for standard risk factors, left atrial volume index was found to be the only significant predictor of the composite end point. In a forward conditional multivariable model, left atrial volume index 40 mL/m(2) or greater (hazard ratio, 4.2 [1.6-10.7]; P = .003) remained an independent predictor, whereas E/e' was borderline significant (P = .06). CONCLUSIONS: In @entity1 with symptomatic severe @entity472 undergoing aortic valve replacement, left atrial volume provides important prognostic information beyond standard risk factors.
