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

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 wi...

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Detalles Bibliográficos
Autores: Butcher, Steele|||0000-0001-8258-8802, Hirasawa, Kensuke|||0000-0002-3812-9825, Meucci, Maria Chiara|||0000-0001-5474-0555, Stassen, Jan|||0000-0001-9745-5498, Kuneman, Jurrien H., Pereira, Ana Rita, Van Der Kley, Frank|||0000-0003-4521-8698, De Weger, Arend|||0000-0002-4190-3156, Van Rosendael, Philippe J., Marsan, Nina Ajmone|||0000-0001-7208-5769, Playford, David|||0000-0003-4492-1103, Delgado, Victoria|||0000-0002-9841-2737, Bax, Jeroen J|||0000-0001-7368-0500
Tipo de recurso: artículo
Fecha de publicación:2024
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:311539
Acceso en línea:https://ddd.uab.cat/record/311539
https://dx.doi.org/urn:doi:10.1093/ehjci/jeae170
Access Level:acceso abierto
Palabra clave:TAVI
Aortic stenosis
Diastolic dysfunction
Left atrial strain
Outcome
Descripción
Sumario: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.

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