Lukas Stolz, Simon Schmid, Julius Steffen, Philipp M Doldi, Ludwig T Weckbach, Thomas J Stocker, Kornelia Löw, Carolin Fröhlich, Julius Fischer, Magda Haum, Hans D Theiss, Konstantin Stark, Konstantinos Rizas, Sven Peterss, Michael Näbauer, Christian Hagl, Steffen Massberg, Jörg Hausleiter, Simon Deseive
{"title":"Prognostic impact of left and right atrial strain in patients undergoing transcatheter aortic valve replacement.","authors":"Lukas Stolz, Simon Schmid, Julius Steffen, Philipp M Doldi, Ludwig T Weckbach, Thomas J Stocker, Kornelia Löw, Carolin Fröhlich, Julius Fischer, Magda Haum, Hans D Theiss, Konstantin Stark, Konstantinos Rizas, Sven Peterss, Michael Näbauer, Christian Hagl, Steffen Massberg, Jörg Hausleiter, Simon Deseive","doi":"10.1093/ehjci/jeae322","DOIUrl":null,"url":null,"abstract":"<p><strong>Aims: </strong>Data on the prognostic value of left and right atrial strain after transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS) are limited. Aim of this study was to evaluate outcomes of patients undergoing TAVR stratified by left and right atrial strain.</p><p><strong>Methods and results: </strong>Using data from a high-volume academic center, left and right atrial reservoir strain (LASr and RASr) was obtained in patients who underwent TAVR for severe AS from 2018 until 2021. Patients were stratified into groups with normal atrial function (LASr and RASr normal), uniatrial strain impairment (LASr or RASr impaired) and biatrial strain impairment (LASr and RASr impaired). Endpoints were three-year survival, symptomatic improvement as assessed by New York Heart Association functional class (NYHA class) as well as technical and device success defined by the Valve Academic Research Consortium (VARC-3) composite endpoints. The study included 1888 patients at a mean age of 81.0 ± 7.8 years (44.3% women). Mean LASr and RASr were 16.5 ± 9.4% and 21.6 ± 12.4%, respectively. Optimized cut-offs for mortality prediction were 15.5% for LASr and 15.0% for RASr. LASr and RASr were normal in 751 patients (39.8%). Impairment of either RA or LA strain was observed in 633 patients (33.5%) and 504 patients (26.7%) presented with reduced LA and RA strain. While impairment of either LASr or RASr was associated with a 1.7-fold increased risk of three-year all-cause mortality after adjustment for multiple confounders (95% CI 1.2-2.5, p=0.005), biatrial strain impairment exhibited an even higher three-year mortality risk (HR 2.5, 95% CI 1.7-3.6, p<0.001).</p><p><strong>Conclusions: </strong>Preprocedural assessment of atrial strain is associated with increased three-year mortality and might facilitate outcome prediction and patient selection in patients undergoing TAVR for severe AS.</p>","PeriodicalId":12026,"journal":{"name":"European Heart Journal - Cardiovascular Imaging","volume":" ","pages":""},"PeriodicalIF":6.7000,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Heart Journal - Cardiovascular Imaging","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/ehjci/jeae322","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Aims: Data on the prognostic value of left and right atrial strain after transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS) are limited. Aim of this study was to evaluate outcomes of patients undergoing TAVR stratified by left and right atrial strain.
Methods and results: Using data from a high-volume academic center, left and right atrial reservoir strain (LASr and RASr) was obtained in patients who underwent TAVR for severe AS from 2018 until 2021. Patients were stratified into groups with normal atrial function (LASr and RASr normal), uniatrial strain impairment (LASr or RASr impaired) and biatrial strain impairment (LASr and RASr impaired). Endpoints were three-year survival, symptomatic improvement as assessed by New York Heart Association functional class (NYHA class) as well as technical and device success defined by the Valve Academic Research Consortium (VARC-3) composite endpoints. The study included 1888 patients at a mean age of 81.0 ± 7.8 years (44.3% women). Mean LASr and RASr were 16.5 ± 9.4% and 21.6 ± 12.4%, respectively. Optimized cut-offs for mortality prediction were 15.5% for LASr and 15.0% for RASr. LASr and RASr were normal in 751 patients (39.8%). Impairment of either RA or LA strain was observed in 633 patients (33.5%) and 504 patients (26.7%) presented with reduced LA and RA strain. While impairment of either LASr or RASr was associated with a 1.7-fold increased risk of three-year all-cause mortality after adjustment for multiple confounders (95% CI 1.2-2.5, p=0.005), biatrial strain impairment exhibited an even higher three-year mortality risk (HR 2.5, 95% CI 1.7-3.6, p<0.001).
Conclusions: Preprocedural assessment of atrial strain is associated with increased three-year mortality and might facilitate outcome prediction and patient selection in patients undergoing TAVR for severe AS.
期刊介绍:
European Heart Journal – Cardiovascular Imaging is a monthly international peer reviewed journal dealing with Cardiovascular Imaging. It is an official publication of the European Association of Cardiovascular Imaging, a branch of the European Society of Cardiology.
The journal aims to publish the highest quality material, both scientific and clinical from all areas of cardiovascular imaging including echocardiography, magnetic resonance, computed tomography, nuclear and invasive imaging. A range of article types will be considered, including original research, reviews, editorials, image focus, letters and recommendation papers from relevant groups of the European Society of Cardiology. In addition it provides a forum for the exchange of information on all aspects of cardiovascular imaging.