The influence of transcatheter aortic valve replacement on left atrial mechanics: a systematic review and meta-analysis

Author:

Meredith Thomas123ORCID,Brown Lauren4,Mohammed Farhan2,Pomeroy Amy2,Roy David13,Muller David W M13,Hayward Christopher123ORCID,Feneley Michael123,Namasivayam Mayooran123

Affiliation:

1. Department of Cardiology, St Vincent’s Hospital , Level 4, Xavier Building, 438 Victoria Street, Darlinghurst, NSW 2010 , Australia

2. Victor Chang Cardiac Research Institute , 405 Liverpool Street, Darlinghurst, NSW 2010 , Australia

3. Faculty of Medicine and Health, University of New South Wales , Sydney, NSW 2052 , Australia

4. Faculty of Medicine and Health, The University of Sydney , Camperdown, NSW 2050 , Australia

Abstract

Abstract Aims The morphology and function of the left atrium (LA) are intimately tied to left ventricular loading conditions. Data pertaining to the effect of transcatheter aortic valve replacement (TAVR) on LA function and geometry are scarce. The aim of the study was to quantify associations between TAVR and LA remodelling by pooling available data from published observational studies. Methods and results A systematic review and meta-analysis were performed. Studies reporting serial LA speckle-tracking echocardiographic (STE) data, before and after TAVR, were included. Other outcome data included LA area and indexed volume (LAVi) and standard chamber measurements. Outcomes were stratified by timing of follow-up echocardiography: early (<6 months) or late (≥6 months). Twelve studies were included, comprising 1066 patients. The mean reduction in LAVi was 2.72 mL/m2 [95% confidence interval (CI) 1.37–4.06, P < 0.01]. LA reservoir function improved overall by a mean difference (MD) of 3.71% (95% CI 1.82–5.6, P < 0.01), although there was significant heterogeneity within the pooled studies (I2 = 87.3%). Significant improvement in reservoir strain was seen in both early follow-up (MD 3.1%, P < 0.01) and late follow-up studies (MD 4.48%, P = 0.03), but heterogeneity remained high (I2 = 65.23 and 94.4%, respectively). Six studies reported a change in LA contractile function, which recovered in the early follow-up studies (MD 2.26, P < 0.01), but not in the late group (MD 1.41, P = 0.05). Pooled improvement in LA booster function was 1.96% (95% CI 1.11–2.8, P < 0.01). Conclusion TAVR is associated with significant negative LA remodelling, and an improvement in LA mechanics, quantified by STE. The prognostic implications of these findings require further study.

Funder

Cardiac Society of Australia and New Zealand

National Heart Foundation Research Scholarships

National Heart Foundation of Australia Postdoctoral Fellowship

St Vincent’s Clinic Foundation/St Vincent’s Applied Medical Research Institute Clinician

New South Wales Ministry of Health Early-Mid Career Investigator Award

Ramaciotti Foundation Health Investment

NVIDIA Corporation Academic Hardware

Publisher

Oxford University Press (OUP)

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