Prognostic implications and alterations in left atrial deformation following transcatheter aortic valve implantation

Author:

Butcher Steele C12ORCID,Hirasawa Kensuke13ORCID,Meucci Maria Chiara14,Stassen Jan15ORCID,Kuneman Jurrien H1,Pereira Ana Rita16,van der Kley Frank1ORCID,de Weger Arend7ORCID,van Rosendael Philippe J1,Marsan Nina Ajmone1,Playford David8ORCID,Delgado Victoria19,Bax Jeroen J110ORCID

Affiliation:

1. Department of Cardiology, Heart Lung Center, Leiden University Medical Center , Albinusdreef 2, 2300 RC Leiden , The Netherlands

2. Department of Cardiology, Royal Perth Hospital , Perth, WA , Australia

3. Department of Cardiovascular Medicine, Tokyo Medical and Dental University , Tokyo , Japan

4. Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart , Rome , Italy

5. Department of Cardiology, Jessa Hospital Hasselt , Stadsomvaart 11, 3500 Hasselt , Belgium

6. Department of Cardiology, Hospital Garcia de Orta , Almada , Portugal

7. Department of Cardio-Thoracic Surgery, Leiden University Medical Center , 2300 RC Leiden , The Netherlands

8. School of Medicine, University of Notre Dame , Fremantle, WA , Australia

9. Heart Institute, Hospital University Germans Trias i Pujol , Badalona , Spain

10. Heart Center, University of Turku and Turku University Hospital , Turku , Finland

Abstract

Abstract Aims To evaluate the prognostic implications of the left atrial reservoir strain–defined diastolic dysfunction (LARS-DD) grade in patients undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) and to determine whether post-TAVI LARS was more closely associated with new-onset atrial fibrillation than pre-TAVI LARS. Methods and results Pre-TAVI LARS-DD was evaluated by speckle-tracking echocardiography and was assigned as Grade 0 to 1 (LARS ≥24%), Grade 2 (LARS 19–24%), and Grade 3 (LARS <19%). Patients were followed up for the primary endpoint of all-cause mortality from the date of TAVI. For the secondary endpoint, patients with pre- and post-TAVI LARS measurements and no history of atrial fibrillation were evaluated for the occurrence of new-onset atrial fibrillation. A total of 601 patients [median age 81 (76–85) years, 53% males] were included. Overall, 169 patients (28%) were LARS-DD Grade 0/1, 96 patients (16%) were LARS-DD Grade 2, and 336 (56%) were LARS-DD Grade 3. Over a median follow-up of 40 (interquartile range 26–58) months, a total of 258 (43%) patients died. In a comprehensive multivariable Cox regression model, the LARS-DD grade was independently associated with all-cause mortality [adjusted hazard ratio (HR) 1.28 per one-grade increase, 95% confidence interval (CI) 1.07–1.53, P = 0.007]. For the secondary endpoint of new-onset atrial fibrillation, a total of 285 patients were evaluated. Post-TAVI LARS (subdistributional HR 1.14 per 1% <20%, 95% CI 1.05–1.23, P = 0.0009), but not pre-TAVI LARS (P = 0.93), was independently associated with new-onset atrial fibrillation. Conclusion An increased LARS-DD grade was independently associated with long-term post-TAVI survival in patients with severe AS. Post-TAVI LARS was closely related to the occurrence of new-onset atrial fibrillation.

Publisher

Oxford University Press (OUP)

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