Left Atrial Volume Index in Asymptomatic Aortic Stenosis
Left Atrial Volume Index in Asymptomatic Aortic Stenosis
Aortic stenosis results in increased filling pressures of the heart. Size and function of the
 left atrium may be a marker for more advanced heart disease (heart failure) in patients with
 severe aortic stenosis, not presenting any apparent symptoms.

 The goal of this study is to establish the importance and possible implications of left
 atrial dilation in asymptomatic patients with aortic valve stenosis.
Aortic valve stenosis (AS) is the most common valvular disease in the western world. Mild and
 moderate AS generally is well tolerated severe AS is associated with considerable morbidity
 and mortality.

 The consequence of AS is increased pressure load on the left ventricle, which causes changes
 in the ventricular function and structure (Left ventricular remodeling, hypertrophy,
 fibrosis).

 With longstanding elevated filling pressures the left atrium will dilate and heart failure
 symptoms will develop.

 When apparent, symptoms of heart failure, in AS are associated with high mortality rate and
 aortic valve replacement (AVR) is recommended.

 The clinical assessment of heart failure symptoms in AS is however challenging particularly
 in the elderly, as symptoms progress slowly and may mimic age related fragility.

 In this observational study, the goal is to investigate the importance and possible
 implications of left atrial dilation and heart failure among 100 patients with asymptomatic
 severe aortic stenosis. Participants undergo echocardiographic evaluation for diastolic heart
 failure and we assess myocardial fibrosis using magnetic resonance imaging and exercise
 testing with invasive hemodynamic monitoring (right heart catheterization).

 LA dilatation may potentially identify patients likely benefiting of early surgery. The
 importance and possible implications of LA dilatation in asymptomatic AS patients has however
 not yet been established.
Inclusion Criteria:

 -  Asymptomatic severe aortic stenosis (Vmax > 3.5 m/sec and aortic valve area < 1 cm2).

 Exclusion Criteria:

 -  Moderate LV systolic dysfunction (LVEF < 50%)

 -  Concomitant moderate-severe aortic valve regurgitation

 -  Concomitant moderate-severe mitral valve regurgitation

 -  Moderate to severe nephropathy

 -  Chronic or persistent atrial fibrillation

 -  Implanted pacemaker or cardio defibrillator

 -  Disability to exercise testing.