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.