Effect of transcatheter aortic valve replacement on left atrial function.

Abstract

To investigate the effect of transcatheter aortic valve replacement on left atrial volumetric function and left atrial volume for the prediction of adverse outcomes. This is a retrospective analysis of 121 patients in sinus rhythm who underwent TAVR for severe AS. Maximum LA volume index (LAVI max), minimum LA volume index (LAVI min), and "pre-A" volume index (LAVIpre-A, the volume before atrial contraction) were measured by biplane Simpson's method at baseline, 1month, and 1year. The reservoir function, conduit function, booster pump function were calculated. All patients were followed for new-onset of atrial fibrillation, hospitalization and all-cause mortality. The reservoir function, conduit function and booster function before TAVR were 46%, 21%, 32%, respectively. LA volumetric function assessment demonstrated that reservoir function, conduit function increased over the time (all P<0.01). There was no difference in booster function after TAVR (P=0.18). Baseline markedly enlarged LA was significantly increased for AF (HR: 4.72; 95% CI, 1.11-20.13, P=0.04). In addition, There was a progressive decrease in LAVI max (P=0.02) and RVSP (P=0.03) over the time in non-AF group but not in AF group (P=0.62 and P=0.65, respectively). Although, the proportion of high left ventricular filling pressure decreased in both groups but a marked decrease was noted in non AF group in compared with AF group. Reservoir function, conduit function increased over time. Lack of negative LA remodeling post TAVR was associated with higher incidence of AF.