INTRODUCTION.
The management of patients with asymptomatic significant aortic
regurgitation (sAR) is often challenging and appropriate timing of
aortic valve surgery remains controversial.
According to the latest guidelines, among patients with sAR, surgery is
formally recommended when it causes symptoms, left ventricular ejection
fraction (LVEF) ≤50% or if there is a concomitant indication for
cardiac surgery (i.e. significant enlargement of ascending aorta). In
addition, surgery should be considered in asymptomatic patients with
severe LV dilation (end-diastolic diameter >70mm or
end-systolic >50mm) (1).
There are no strong indicators to recommend early surgery in patients
with sAR, however delaying the time for the intervention could bring
potential negative consequences, such as the risk of permanent LV
dysfunction, heart failure or sudden cardiac death (2). In this context,
the identification of markers that are early altered in the natural
history of the sAR, could be useful in order to improve the management
of these asymptomatic patients.
The prognostic value of diastolic parameters has been demonstrated in
several cardiac diseases. In particular, left atrial (LA) function has
been shown to be an important determinant of morbimortality. More
specifically, LA strain is a promising tool for the detection of
subclinical cardiac dysfunction (3).
The purpose of this study was to analyze the prognostic significance of
diastolic function parameters, included LA strain, in asymptomatic
patients with sAR and to evaluate whether these parameters could help to
identify patients at high risk of adverse events that could benefit from
early cardiac surgery.