Relative longitudinal strain apical sparing pattern and low albumin as detrimental factors of cardiovascular outcome after transcatheter aortic valve replacement

Abstract

Abstract Background Relative apical sparing pattern (RASP) of longitudinal strain (LS), a typical echocardiographic feature of cardiac amyloidosis, is associated with cardiac death or heart failure admission in severe aortic stenosis (AS) patients, and associated with all-cause death among elderly patients with severe AS undergoing transcatheter aortic valve replacement (TAVR). Purpose Present study aimed to explore clinical and echocardiographic determinants of short-term and long-term CV outcome (including CV death and CV hospitalization) in symptomatic severe AS patients after TAVR, and to assess the independent and incremental prognostic value of RASP on CV outcome in TAVR patients. Methods This retrospective study comprised 598 consecutive AS patients underwent TAVR (mean age 81.7±5.7 years, 48.7% male). Pre-operative clinical and echocardiography data, including 2D speckle tracking imaging indexes, were analyzed. Clinical outcomes included CV death and procedure related complications at 30 days, 1 year, and at 2 years after TAVR. Results Relative apical sparing pattern (RASP) of longitudinal strain (LS) was defined as ≥3 LV wall segments with the apical-basal LS ratio >3.0. The prevalence of RASP was 19.2%. Compared with patients without RASP, patients with RASP were associated with higher risk of acute kidney injury (AKI, 10.4% vs. 3.3%, P=0.001) and new-onset left bundle branch block (LBBB) after TAVR (17.4% vs. 6.8%, P<0.001) and higher 2-year CV mortality (22.6% vs. 9.9%, P<0.001, Figure 1) after TAVR. Lower pre-procedural albumin level and RASP were identified as independent determinants of increased 2-year CV mortality (RASP: HR=2.178, P=0.002; albumin<4.0g/dl: HR= 2.548, P<0.001), regardless of TAVR approach and EuroSCORE II. After adjustment, the addition of RASP significantly improved prognostic power of a model including clinical variables and low albumin level for predicting 2-year CV death (χ2 from 28.179 to 40.699, P=0.001, Figure 2). Conclusion RASP is a significant determinant of AKI and new-onset LBBB after TAVR. RASP together with low pre-procedural albumin level serve as the strongest determinants of increased risk of 2-year CV mortality after TAVR.Figure 1Figure 2