{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T03:11:36Z","timestamp":1793502696926,"version":"4.5.0"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Aortic stenosis (AS) induces left ventricular diastolic dysfunction, which is associated with left atrial (LA) dysfunction. However, the prognostic impact of LA dysfunction in the surgical intervention for AS remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Among the 812 patients who underwent isolated surgical aortic valve replacement (SAVR) for AS at 8 institutions between 2016 and 2021, 366 with available preoperative left atrial volume index (LAVI) were included. Based on the optimal value of 40 mL\/m2\u2014derived from receiver operating characteristic curve analyses\u2014patients were stratified into a LA enlargement group (n\u2009=\u2009219) and a non-enlargement group (n\u2009=\u2009147), and 5-year outcomes were investigated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Age (76.0 vs 76.0 years, P\u2009=\u2009.489) and sex (male 44.3% vs 50.3%, P\u2009=\u2009.256) were comparable, while the LA enlargement group showed lower estimated glomerular filtration rate (eGFR) (52.3 vs 59.2 mL\/min\/1.73 m2, P\u2009=\u2009.002), serum albumin (3.9 vs 4.0 g\/dL, P\u2009=\u2009.003), and ejection fraction (65.0% vs 70.0%, P\u2009&amp;lt;\u2009.001), as well as a higher tendency for atrial fibrillation (20.1% vs 12.2%, P\u2009=\u2009.066), and higher Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) (3.10% vs 2.91%, P\u2009=\u2009.029). The 5-year incidence of cardiac mortality was higher in the LA enlargement group (13.4% vs 2.6%, P\u2009=\u2009.001). Multivariable analysis identified preoperative LA enlargement (LAVI\u2009\u2265\u200940 mL\/m2) as an independent predictor of cardiac mortality (adjusted hazard ratio [HR], 2.08; 95% confidence interval [CI], 1.01-4.82; P\u2009=\u2009.041). Left atrial enlargement was also associated with higher all-cause mortality and heart failure readmission (17.4% vs 7.6%, P\u2009=\u2009.002; and 11.0% vs 2.8%, P\u2009=\u2009.013, respectively).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In patients with severe AS undergoing isolated SAVR, a preoperative LAVI\u2009\u2265\u200940 mL\/m2 was associated with midterm mortality and heart failure, suggesting that SAVR before significant LA enlargement may improve prognosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejcts\/ezag022","type":"journal-article","created":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T12:38:39Z","timestamp":1768048719000},"source":"Crossref","is-referenced-by-count":2,"title":["Left Atrial Volume Index as a Risk Predictor in Isolated Surgical Aortic Valve Replacement: Results from the Multicentre Aortic Valve Replacement Registry"],"prefix":"10.1093","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6080-2166","authenticated-orcid":false,"given":"Kazuma","family":"Handa","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, The University of Osaka Graduate School of Medicine , Osaka, 565-0871,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1102-111X","authenticated-orcid":false,"given":"Koichi","family":"Maeda","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, The University of Osaka Graduate School of Medicine , Osaka, 565-0871,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyongsun","family":"Pak","sequence":"additional","affiliation":[{"name":"Division of Biostatistics, Center for Clinical Research, National Center for Child Health and Development , Setagaya, 157-8535,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Yanagino","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, The University of Osaka Graduate School of Medicine , Osaka, 565-0871,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahiro","family":"Ohmori","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, The University of Osaka Graduate School of Medicine , Osaka, 565-0871,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akinobu","family":"Ohtani","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, The University of Osaka Graduate School of Medicine , Osaka, 565-0871,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9646-332X","authenticated-orcid":false,"given":"Takura","family":"Taguchi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, The University of Osaka Graduate School of Medicine , Osaka, 565-0871,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kunitaka","family":"Kumagai","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, The University of Osaka Graduate School of Medicine , Osaka, 565-0871,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koichi","family":"Inoue","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, The University of Osaka Graduate School of Medicine , Osaka, 565-0871,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shohei","family":"Yamada","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, The University of Osaka Graduate School of Medicine , Osaka, 565-0871,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Misumi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, The University of Osaka Graduate School of Medicine , Osaka, 565-0871,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kizuku","family":"Yamashita","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, The University of Osaka Graduate School of Medicine , Osaka, 565-0871,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4199-9864","authenticated-orcid":false,"given":"Ai","family":"Kawamura","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, The University of Osaka Graduate School of Medicine , Osaka, 565-0871,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4656-7317","authenticated-orcid":false,"given":"Daisuke","family":"Yoshioka","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, The University of Osaka Graduate School of Medicine , Osaka, 565-0871,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1481-0795","authenticated-orcid":false,"given":"Kazuo","family":"Shimamura","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, The University of Osaka Graduate School of Medicine , Osaka, 565-0871,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shigeru","family":"Miyagawa","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, The University of Osaka Graduate School of Medicine , Osaka, 565-0871,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,1,12]]},"reference":[{"key":"2026031210213916100_ezag022-B1","doi-asserted-by":"publisher","first-page":"853","DOI":"10.1038\/s41569-021-00570-z","article-title":"Global epidemiology of valvular heart disease","volume":"18","author":"Coffey","year":"2021","journal-title":"Nat Rev Cardiol"},{"key":"2026031210213916100_ezag022-B2","doi-asserted-by":"publisher","first-page":"1003233","DOI":"10.3389\/fcvm.2022.1003233","article-title":"Global burden of calcific aortic valve disease and attributable risk factors from 1990 to 2019","volume":"9","author":"Yu","year":"2022","journal-title":"Front Cardiovasc Med"},{"key":"2026031210213916100_ezag022-B3","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezaf200","article-title":"The choice of surgical aortic valve replacement type and mid-term outcomes in 50 to 65-year-olds: results of the AUTHEARTVISIT study","volume":"67","author":"Florian","year":"2025","journal-title":"Eur J Cardio-Thorac Surg"},{"key":"2026031210213916100_ezag022-B4","doi-asserted-by":"publisher","first-page":"e247525","DOI":"10.1001\/jamanetworkopen.2024.7525","article-title":"Comparative long-term clinical performance of mechanical aortic valve prostheses","volume":"7","author":"Granbom Koski","year":"2024","journal-title":"JAMA Netw Open"},{"key":"2026031210213916100_ezag022-B5","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1016\/j.athoracsur.2023.10.006","article-title":"Survival after surgical aortic valve replacement in low-risk patients: a contemporary trial benchmark","volume":"117","author":"Thourani","year":"2024","journal-title":"Ann Thorac Surg"},{"key":"2026031210213916100_ezag022-B6","doi-asserted-by":"publisher","first-page":"783","DOI":"10.1016\/j.jacc.2022.05.006","article-title":"Evolution and prognostic impact of cardiac damage after aortic valve replacement","volume":"80","author":"G\u00e9n\u00e9reux","year":"2022","journal-title":"J Am Coll Cardiol"},{"key":"2026031210213916100_ezag022-B7","doi-asserted-by":"publisher","first-page":"2037","DOI":"10.1253\/circj.CJ-20-0135","article-title":"JCS\/JSCS\/JATS\/JSVS 2020 guidelines on the management of valvular heart disease","volume":"84","author":"Izumi","year":"2020","journal-title":"Circ J"},{"key":"2026031210213916100_ezag022-B8","first-page":"e72","article-title":"2020 ACC\/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"143","author":"Otto","year":"2021","journal-title":"Circulation"},{"key":"2026031210213916100_ezag022-B9","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1093\/ejcts\/ezab389","article-title":"ESC\/EACTS guidelines for the management of valvular heart disease","volume":"60","author":"Vahanian","year":"2021","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026031210213916100_ezag022-B10","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1002\/clc.23952","article-title":"The predictive value of changes in left atrial volume index for rehospitalization in heart failure with preserved ejection fraction","volume":"46","author":"Hao","year":"2023","journal-title":"Clin Cardiol"},{"key":"2026031210213916100_ezag022-B11","doi-asserted-by":"publisher","first-page":"e040646","DOI":"10.1161\/JAHA.124.040646","article-title":"Left atrial volumetric\/mechanical coupling index in heart failure with preserved ejection fraction","volume":"14","author":"Okada","year":"2025","journal-title":"J Am Heart Assoc"},{"key":"2026031210213916100_ezag022-B12","doi-asserted-by":"publisher","first-page":"e019545","DOI":"10.1161\/JAHA.120.019545","article-title":"Prognostic value of minimal left atrial volume in heart failure with preserved ejection fraction","volume":"10","author":"Shin","year":"2021","journal-title":"J Am Heart Assoc"},{"key":"2026031210213916100_ezag022-B13","doi-asserted-by":"publisher","first-page":"952","DOI":"10.1111\/echo.15662","article-title":"Assessment of subclinical left ventricular systolic dysfunction in patients with asymptomatic severe aortic stenosis with preserved left ventricular systolic function by three-dimensional speckle tracking echocardiography","volume":"40","author":"Nahar","year":"2023","journal-title":"Echocardiography"},{"key":"2026031210213916100_ezag022-B14","doi-asserted-by":"publisher","first-page":"791","DOI":"10.1016\/j.echo.2022.03.008","article-title":"Left ventricular global longitudinal strain in patients with moderate aortic stenosis","volume":"35","author":"Stassen","year":"2022","journal-title":"J Am Soc Echocardiogr"},{"key":"2026031210213916100_ezag022-B15","doi-asserted-by":"crossref","first-page":"2717","DOI":"10.1016\/j.jacc.2021.02.038","article-title":"Valve Academic Research Consortium 3: updated endpoint definitions for aortic valve clinical research","volume":"77","author":"Varc","year":"2021","journal-title":"J Am Coll Cardiol"},{"key":"2026031210213916100_ezag022-B16","doi-asserted-by":"publisher","first-page":"G1","DOI":"10.1530\/ERP-19-0050","article-title":"Normal reference intervals for cardiac dimensions and function for use in echocardiographic practice: a guideline from the British Society of Echocardiography","volume":"7","author":"Harkness","year":"2020","journal-title":"Echo Res Pract"},{"key":"2026031210213916100_ezag022-B17","doi-asserted-by":"publisher","first-page":"1305","DOI":"10.1007\/s40520-023-02395-x","article-title":"Prognostic significance of controlling nutritional status in older adults with heart failure with preserved ejection fraction: a prospective comparative study with other objective nutritional indices","volume":"35","author":"Chen","year":"2023","journal-title":"Ageing Clin Exp Res"},{"key":"2026031210213916100_ezag022-B18","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1093\/ehjci\/jeaa418","article-title":"Echocardiographic measures and subsequent decline in kidney function in older adults: the atherosclerosis risk in communities study","volume":"23","author":"Ishigami","year":"2022","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2026031210213916100_ezag022-B19","doi-asserted-by":"publisher","first-page":"3367","DOI":"10.1111\/jgs.18590","article-title":"Malnutrition in heart failure with preserved ejection fraction","volume":"71","author":"Zainul","year":"2023","journal-title":"J Am Geriatr Soc"},{"key":"2026031210213916100_ezag022-B20","doi-asserted-by":"publisher","first-page":"771","DOI":"10.1016\/j.jtcvs.2021.11.055","article-title":"Atrial fibrillation in severe aortic stenosis: prognostic value and results of aortic valve replacement","volume":"166","author":"Kubala","year":"2023","journal-title":"J Thorac Cardiovasc Surg"}],"container-title":["European Journal of Cardio-Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ejcts\/advance-article-pdf\/doi\/10.1093\/ejcts\/ezag022\/66379126\/ezag022.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/68\/3\/ezag022\/66379126\/ezag022.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/68\/3\/ezag022\/66379126\/ezag022.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T14:21:48Z","timestamp":1773325308000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejcts\/article\/doi\/10.1093\/ejcts\/ezag022\/8423036"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,12]]},"references-count":20,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3,10]]}},"URL":"https:\/\/doi.org\/10.1093\/ejcts\/ezag022","relation":{},"ISSN":["1010-7940","1873-734X"],"issn-type":[{"value":"1010-7940","type":"print"},{"value":"1873-734X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,3]]},"published":{"date-parts":[[2026,1,12]]},"article-number":"ezag022"}}