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

Abstract

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Swiss Heart Foundation, Novartis Foundation. Introduction Speckle-tracking echocardiography is an increasingly important tool for the assessment of degenerative aortic stenosis (AS), the most common valvular heart disease in the Western world with growing prevalence in the aging population. Left atrial reservoir (LARS) and pump strain (LAPS) were studied for their association with all-cause 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 registry, 198 patients with severe AS were identified who underwent TAVI and had a comprehensive echocardiographic examination prior to the procedure, allowing full target analysis with TomTec Image Arena. 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 (LARS (21.7 % (6.9); LAPS (−9.5 % (4.5)) impaired in the study population, while left ventricular ejection fraction (LVEF) (56.7 % (11.5)) was preserved. During a median follow-up time of 1835 [IQR 1371 – 2337] days, 70 patients (35.4 %) died. There was no significant difference between women and men. LARS and LAPS were lower in non-survivors (20.3 % (6.7) and −8.4 % (4.1), respectively; Figure 1) than survivors (22.5 % (6.9); P = 0.034 and −10.1 % (4.6); P = 0.012; Figure 1), while LAVI did not differ (P = 0.175). In univariable Cox regression models, LAPS was associated with all-cause mortality (HR 1.06 [95% CI 1.01 – 1.12]; P = 0.029; ꭓ2 5.03; ꭓ2 P = 0.025), while LARS was not (HR 0.97 [0.94 – 1.01]; P = 0.120; ꭓ2 2.50; ꭓ2 P = 0.114). In bivariable models, association of LAPS with mortality was independent of gender (data not shown), STS-Score, LVEF and LAVI (Figure 2). Likelihood ratios revealed that inclusion of LAPS to STS-Score, LVEF or LAVI improved the fitness of predictive models (Figure 2), while that of LARS did not (data not shown). Conclusions LAPS was associated with mortality after TAVI, while LARS and LAVI were not. The association of LAPS was independent of STS-Score, LVEF, and LAVI and showed potential incremental value for assessment of outcome association. Hence, left atrial dysfunction as reflected by LAPS was a predictor of mortality and may be a useful follow-up parameter after TAVI.