RESULTS.
A total of 126 patients were included. Mean age of the patients was 70 ± 17,0 years. Among them, 25 (19,8%) had bicuspid valve, 75 (59,5%) were men, 78 (62,4%) had hypertension, 44 (35,3%) suffered from dyslipidemia and 11 (9,6%) had concomitant coronary artery disease with preserve LVEF.
During a mean follow up of 33±19 months, 25 (19,8%) patients reached the combined endpoint (n= 5 developed heart failure, n= 25 underwent surgery, and n= 4 died due to cardiovascular etiology). Another 3 patients that had undergone valve surgery exclusively due to aortic dilatation and another 7 patients that had died from an extracardiac etiology were not included in the cardiovascular event group. Clinical and echocardiographic characteristics of both groups (control and cardiovascular event group) are displayed in table 1.
Univariate analysis showed that LV volumes, LVEF, E wave, E/e’ ratio, LA volume, PSAP and LASr were significant predictors of events, whereas LA diameter and LV diastolic diameter were not. Statistical significance was maintained in the analysis adjusted for age and sex (Table 2). Multivariate model 1 that tested all echocardiographic variables statistically significant in the univariate model showed that the E/e’ ratio (p= 0,01) and LVEDV (p< 0,001), were significant predictors of events (Table 2).
In a sub-group of 57 patients LA auto-strain analysis was obtained. During the same follow-up period, 8 (14%) patients developed the combined endpoint (7 patients underwent surgery, one of them developed previous heart failure and died due to cardiovascular etiology). Another 3 patients that underwent valve surgery exclusively due to aortic dilatation were excluded from the cardiovascular event group. In this subgroup of patients with LA autostrain analyzed, a second multivariate model was built, including the previous significant variables for the first model (LVEDV and E/e’ ratio) and the LASr. This model showed that LVDEV (p= 0,016) and LASr (p= 0,035) were the most significant predictors of cardiovascular events (Table 2).
Area under the receiver-operating characteristic (AUC) curve was used to evaluate LASr accuracy to predict cardiovascular events (AUC= 0,78 p= 0,012) (Figure 2). Kaplan Meier curve, stratified by median value of LASr, showed that lower LASr values (less than median of 34%) were associated with higher rates of events (p= 0,013) (Figure 3).