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).