Left ventricular early diastolic strain rate predicts mortality after transcatheter aortic valve implantation

Abstract

Abstract Introduction Speckle-tracking echocardiography is an increasingly important tool for assessing degenerative aortic valve stenosis (AS). This study aims to analyse left ventricular early diastolic strain rate (eSR) in patients with severe AS undergoing transcatheter aortic valve implantation (TAVI) and explore its association with mortality during long-term follow-up. Methods From our prospective AS cohort study, 100 patients with severe AS and a comprehensive echocardiographic examination prior to TAVI were identified and eSR was determined using TomTec ImageArena v.4.6 (Figure A). All-cause five-year mortality was defined as the endpoint.± Results Baseline characteristics were comparablebetween non-survivors (14%) and survivors (86%) except for a higher STS-Score among the former (non-survivors: 3.6 [2.7–7.4]%; survivors: 2.6 [1.8–3.7]%; P=0.024). There was no significant difference between non-survivors and survivors with regard to LVEF (54 [50–58]% vs 58 [52–63]%; P=0.069) and LVGLS (-14.8 [-15.8 to -12.7]% vs -15.4 [-15.8 to -14.7]%; P=0.339). In contrast, eSR was significantly lower in non-survivors (0.72 [0.67–0.87]s-1) than survivors (0.88 [0.73–1.22]s-1); P=0.013; Figure B). Patients with an eSR ≤ 0.72 s-1 (ROC AUC 71%; P=0.008) exhibited a lower survival probability as revealed by Kaplan-Meier survival analysis (P=0.001; Figure C). Inclusion of eSR improved the fitness (2) of a multivariable logistic regression model for LV systolic function (LVEF and LVGLS; Figure D). A similar effect was observed when eSR was included in a model for LV diastolic function (E/A and E/e’; Figure D). These improvements in 2 were significant for both models (ANOVA P=0.026, and P=0.037, respectively). Conclusions eSR differentiated non-survivors from survivors and was associated with long-term mortality after TAVI. This association was independent of and improved outcome prediction by LV systolic or diastolic function parameters. These findings highlight the potential value of eSR for assessing long-term mortality after TAVI.Figures