Abstract 13977: The Impact of Left Atrial Functional Changes on Clinical Outcomes Following Transcatheter Aortic Valve Replacement

Abstract

Background: In patients with aortic stenosis (AS) and preserved left ventricular (LV) function, pre-intervention left atrial (LA) enlargement is common and predicts adverse events. Changes in LA function are appropriate markers of LV response to AS but have not been well explored in patients undergoing TAVI. The objectives of the current study were to evaluate changes in LA function following TAVI and their impact upon clinical outcomes. Methods: A total of 313 consecutive patients undergoing TAVI were included. There were 160 (51%) paired echocardiographic datasets with a median time of 1 (range 0-57) days pre-TAVI and a median time of 120 (1.2-810) days post-TAVI. All studies were evaluated for LA maximum volume index (LAVI max ), LA minimum volume index (LAVI min ), total emptying volume (LAEV), total emptying fraction (LAEF) and expansion index (LAEI). The pre-defined endpoints were cardiac-related hospitalization and all-cause death. Results: During a mean follow-up of 18 (±9.7) months, there were 58 deaths (18.5%) and 35 (11.2%) hospitalizations for heart failure, whereas 9 (2.9%) patients continued to report symptoms (NYHA 3). The prevalence of atrial fibrillation was 16.3% and coronary artery disease 52.7%. In a multivariate cox regression analysis, lower body surface area (HR 3.79; 95% CI 1.07-13.33, p=0.038), higher serum creatinine (HR 1.004; 95% CI 1.002-1.006, p<0.001) and LV ejection fraction (EF) <50% (HR 1.94; 95% CI 1.08-3.48, p=0.027) were predictors of all-cause mortality, independent of age, aortic valve area, the presence of coronary artery disease and time from index echocardiography to TAVI procedure. All LA function parameters demonstrated an improvement following TAVI (Fig. 1). In univariate cox regression analyses, baseline LA functional parameters were not associated with all-cause mortality alone or a composite of all-cause mortality and cardiac related hospitalization. Conclusions: In patients undergoing TAVI, lower body surface area, higher serum creatinine and LVEF <50% were independent predictors of all-cause mortality. TAVI led to successful reverse LA functional and structural remodeling and LV functional recovery. However, pre-TAVI LA functional and structural parameters were not predictors of survival.