Left atrial pump strain predicts long-term mortality in patients undergoing transcatheter aortic valve implantation

Abstract

Abstract Introduction Speckle-tracking echocardiography is an increasingly important tool for assessing aortic stenosis (AS). Left atrial reservoir (LARS) and pump strain (LAPS) were studied for their association with long-term mortality in AS patients undergoing transcatheter aortic valve implantation (TAVI). Purpose To investigate left atrial function assessed by LARS and LAPS and its association with all-cause mortality during long-term follow-up after TAVI. Methods From our prospective AS cohort study, 198 patients with severe AS were identified who underwent TAVI and had a comprehensive preinterventional echocardiographic examination allowing full target analysis. Five-year all-cause mortality was defined as the endpoint. Results Left atrial volume index (LAVI) was increased (mean (SD): 46.9 ml/m2 (±16.5)) and left atrial deformation impaired (LARS (21.7% (±6.9); LAPS (-9.5% (±4.5)), while left ventricular ejection fraction (LVEF) (56.7% (±11.5)) was preserved in the study population. Over a follow-up time of five years, 49 patients (24.7%) died. LARS and LAPS were more impaired in non-survivors (20.0% (±6.5) and -8.1% (±4.0), respectively; Figure) than in survivors (22.3% (±6.9); P=0.042 and -9.9% (±4.5), respectively; P=0.014; Figure), while LAVI did not differ (P=0.248). Univariable Cox regression models demonstrated that LAPS was associated with mortality (P=0.014), while LARS was not (P=0.066) (Table A). In bivariable and multivariable models, the association of LAPS with mortality was independent of LVEF and LAVI, and inclusion of LAPS improved the fitness (≤2) of these models (Table B). Furthermore, the improvement in ≤2 was significant for all models (ANOVA P=0.012, P=0.013, and P=0.015, respectively). Conclusion LAPS was associated with long-term mortality after TAVI, while LARS and LAVI were not. The association of LAPS was independent of LVEF and LAVI and showed potential incremental value for assessment of outcome association. Hence, LAPS may be useful for predicting long-term outcome after TAVI.