SYSTEMATIC REVIEW article
Front. Cardiovasc. Med.
Sec. Heart Valve Disease
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1667871
This article is part of the Research TopicFuture of Heart Valve Surgery: Enhancing Outcomes with Innovative TechnologiesView all 3 articles
Prognostic Value of Left Atrial Strain in Significant Aortic Valve Disease: A Systematic Review and Meta-Analysis
Provisionally accepted
- 1Department of Echocardiography, The First Affiliated Hospital of Dalian Medical University, Dalian, China
- 2Department of Ultrasound, The Second Hospital of Dalian Medical University, Dalian, China
- 3Department of Echocardiography, The Second Hospital of Dalian Medical University, Dalian, China
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Background: Previous studies on aortic valve disease have mainly focused on the left ventricle, but increasing evidence suggests that left atrial strain also has prognostic value in significant aortic valve disease. Objective: To systematically evaluate the prognostic value of left atrial strain in significant aortic valve disease. Methods: Multiple electronic databases were searched for studies evaluating significant aortic stenosis (AS) or aortic regurgitation (AR) using peak left atrial longitudinal strain (PALS) from the inception of each database to 1 February 2025. There were no language or regional restrictions. The primary endpoint was a composite outcome comprising all-cause mortality, hospitalization for heart failure, aortic valve replacement, pulmonary hypertension, and postoperative new-onset atrial fibrillation. Results: A total of 25 studies were included, involving 7195 patients, with2039 (28%) patients experiencing primary endpoint events. The PALS was lower in the positive group (EVENT+) compared to the negative group (EVENT-) (SMD = -1.03, 95% CI [- 1.22, -0.84], p < 0.05). For each unit increase in PALS, the risk of the primary endpoint event decreased by 7% (HR = 0.93, 95% CI [0.91, 0.96], p < 0.001). PALS exhibited consistent incremental predictive value in both the AR and AS cohorts, although the strength of its effect and the underlying mechanisms varied between groups. Conclusion: PALS is an independent predictor of adverse cardiovascular events in patients with significant aortic valve disease. PALS has certain value in the prognosis of significant aortic valve disease.
Keywords: aortic stenosis, Aortic regurgitation, Left atrial strain, Peak left atrial longitudinal strain, Systematic review, Meta-analysis
Received: 17 Jul 2025; Accepted: 01 Sep 2025.
Copyright: © 2025 Chen, Gu and Wu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jun Wu, Department of Echocardiography, The Second Hospital of Dalian Medical University, Dalian, China
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